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� <br />SITE ADDRESS <br />LOT NO. <br />PL,�MlT APPLICA�'IC <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERElT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />�.I.JA �'( <br />BLOCK TRACT <br />PAACEL TAX I.D. # <br />PERPAIT d <br />IJwAYt.11: �. A Nt� <br />TENANTNAME I CONTACTNAME PHONE <br />�hkUC I�HNI—= IJODO� ' <br />CONTRACTOR AODRESS /� ZIP CONTfl.LICENSF.q <br />�1(�L'Ql�.-N S�f1 C� N�T ��C. Z17� (�1-cc'i-(C �l.BZQi L�1L-"RGSSOZZ-cs� <br />PHON6 _ <br />, PROPOSED USE OF BUILDING Building (�Mechanical Addition HEAT SOURCE <br />0���.� /����� PERMIT R�( Combinatiun �_� Plumbing WORK Alteration Electnc <br />( TYPE �,J �emolilion LJ Sign TYPE New ��s <br />U Sprinkler FepaidPdainL Olher <br />' CONTRACT PRICE OF WORK .�j "% jr/j�� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />'��, WORKDESCRIPTION �KN�SC( C� L-j��i4l.� �Z� G� <br />j�Q�lleS E���s'��s� 6'RS �p�p.� i Corc-tu��5 <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />� _ DISHWASHER <br />, LAUNDRY TRAY <br />' CLOTHES WASHER <br />URINAL <br />DRIfJKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE%BAR/MOP/ETC.) <br />OTHER <br />'S <br />N0. I TYPE OF FIXTURE OR ITEM <br />� A/C —A/HANDI.ING UNITS <br />FOFCED AIR SYSTEMS <br />HEATPUMP <br />_ UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />✓ GAS PIPING <br />f� EXHAUST FAN <br />� OTHER A i N'i {"I�'1'l`C�'� <br />I HEFEBY CERITIFY'HAT I HAVE READ AND EXAMINED THIS APPUCATION AND KN01N THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF L4'NS AND ORIDINACFS GOVERNING THIS ll'PE OF WORK WILL BE COMPLIED WITH VJHETHER SPECIFIED HEPEIN OR <br />NOT. THE GRAtJTING OF A PERWIT DOES fJOT PRESUM1tE TO GIVE AUTHORITY TO VIOWTE OF CANCEL THE PROVISION OF ANY OTHEF <br />STATE OR LOCAL LA4V REGULATING CONSTRUCTION OR THE PERFORtdANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNEFa OF THIS PROPEflTY TO FERFORM THE WORK FOR WHICii APPLICATION IS h1ADE AND I COh1PLY WITH THE STATE <br />CONTRACTORS L:W 78.27 RCW AND 296.200 WAC. <br />Signature of Owner,ContractodAuthcrized Agent Date �/\ <br />/ <br />a <br />