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SITE A�DRESS <br />804► C✓E <br />LEGA LOT N0. <br />�w�Y�e �.ArJC <br />_'� ,- <br />: <br />PERMiT APPLICATION <br />CITY OF EVERETT PERMIT SERV9CFS <br />3200 CEDAR STREET, EVEREIT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />PARCEL TAX I.D. # <br />s �.+Ay b7?8 • oSj • oo'� • esoo3 <br />BLOCK TRACT <br />ADDRESS Z�p <br />iaou �vert�,ReuJ «� �il�cT <br />PERh11T # <br />Bo3c <br />�LT • q ooa <br />TENANTNAME CONTACTNAME PHONE <br />pw�yrE ��� I rtosr .3-nNr..C.�! Z S2 • 2 os3 <br />CONTRACTOR �� C��� ADORESS ZIP CONTR. LICENSE p <br />� 1/0�511 Iqf4A.�e C.F �j'�Fi''Nc/ <br />PHONE 3J d• Z I I� D M I�< <� '"{ 9ZO V <br />_ /O� k.� <br />PFOPOSED USE OF BUILDING I �uilding f'1 MechaniCal �Addilion HEAT SDURCE <br />CA� s^�L�j. PERMIT Combination K Plumbing wORK Alteration Electric <br />��,L �:S TYPE Demolilion � Sign TYPE New Gas <br />Sprinkler (N ot heads) RepaidMaint N/ Other <br />GJNTR! CT PRICE OF WORK O. Qa a CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK �[SCRIPTION ��` E� <br />? q`� <br />N0. I TYPE OF FIXTURE OR ITEM <br />_ WATER CLOSET (TOILEi) <br />_ 6ATHTUB <br />_ LAVATORY (WASH BASIN) <br />_ SHOWER <br />_ KITCHEN SINK & DISPOSAL <br />_ DISHWASHER <br />_ LAUNDRYTRAY <br />_ CLOTHES WASHER <br />_ URINAL <br />_ DRINKING FOUNTAIN <br />_ FLOOR DRAIN <br />_ BACKFLOW PREVENTER <br />_ SINK (SERVICE/BAR/MOP/ETC.) <br />_ OTHER <br />�'IfT � 4ta F.R �.a "[ •�►� e� �,C 791 t t� Ar <br />NO. � TYPE OF FIXTURE OR REM <br />A/C — WHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUfv1P <br />UNIi' HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />MEfAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CEHITIFY THAT I HAVE READ qND EXAMINED THIS A'PLICATION AND KNJW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL �� COMPLIED WITH WHEfIiER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PqESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAVJ REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERIY TO PERFORM THE WORK FOR WHICH APPLICATION IS MA�E AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW ANp 2Q6200 WAC. <br />f•o�•O <br />