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( i <br />PtRMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br />�R aSv7 oD� oc 7 od <br />SITE ADDRESS PARCEL TAX I.D. q <br />� ZSoS ���� cn3 oo7c�'} <br />LEGAL LOT NO. BLOCK TRACT <br />DESC. c,CF y� <br />OWNER <br />TENANT NAME <br />�!�— <br />CONTRACTOR <br />(aAt�/'�Y Ccr.15f2!![�lon1 <br />PHONE �,�� 33�—Z� �T <br />PROPOSED USE OF BUILDING <br />s-3 <br />CONTRACT PRICE OF WORK �; <br />WORK DESCRIPTION <br />PERMI7' <br />TYPE <br />ADDRESS <br />CONTACT �N�AyM� <br />1'f(N' <br />ADDRESS <br />Iv511 !9t'� {� S�� � <br />EJEr'�'�'r W A- 90208 <br />Building j� Mechanical <br />Combination r} Plumbing WORK <br />Demolition � Sign TYPE <br />Sprinkler <br />a_ <br />NEiv 7,saz ssQr sEevirE r�u�cv��c� <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BAS�N) <br />SINK & DISPOSAL <br />TRAY <br />URINAL <br />DRINKING FO NTAIN <br />FLOOR DRAIN <br />BACKFLOW PREV ' <br />SINK (SERVICE/BA P <br />P MIT # r <br />o.�� u�ll <br />PHONE <br />"17JH (,FI�JE <br />PHONE <br />� <br />CONTR. LICENSE # <br />(aAFFNct I o¢K3 <br />Addition HEAT SOURCE <br />Alteration ��j(' Electric <br />New �( Gas <br />RepaidMaint. l, Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C —A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />Z`i�OTHES DRYER <br />R'NGEHOOD <br />WAl'�R HEATER <br />FIREPLAG� INSERT <br />GAS FIREPLACE <br />GAS RANGE\ <br />GAS PIPING <br />EXHAUSTFAN <br />I HEREBY C'RITIFY THAT I HAVE READ AND EXAfviI�ED THIS APP'_ICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISION6 OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfH£R SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPIICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONSPrFCT�FlS WW 18.27 RCW AND 29fi.200 WAC. <br />(J �' 1 S' GC.LIl� ,^` <br />Agent . Daie � �Z <br />