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� <br />� <br />SITE ADDflESS <br />DESC. <br />OWNER <br />Ti'� �r�,� r <br />TENANTNAME <br />PF�.�MIT APPLICATIG� � <br />CITY OF EVERETT PcRM1T SERVICES <br />3200 CEDAR STREET, rVERETT, WA 98201, 425-257-8810 <br />��������j2-_;�� �.,; <br />CONTRACTOFi p ? <br />Li1MYY1L'�( �^���k �i2, `11,'�1C�11� <br />PHONE .� 1��� � �(�'� <br />PROPOSED USE OF BUILDING <br />: �� i PERMI7 <br />'��� � � �� TYPE <br />CONTRACT PRICE OF WORK �� <br />PAFCEL TAX I.D. # <br />�,ADDflESS <br />1'u f;>��1� I ��``� <br />NAME <br />PERMIT n <br />r �/ <br />� ��JC' <br />PHONE <br />PHONE <br />DORESS �� ��I �� �V ' CONTR. LICENSc � <br />; <br />� ��'�� � "' �, ��� ��� ����,- �-� ;�C��l�i�����Fi1��n��,' <br />Ili;l,�i -�� ��E (r�(.,, � 1,., i� ��-;. �'� �; <br />Building � Mechanical AdCition HEAT SOURCE <br />Combination Plumbing WORK Aireration Eler,ric <br />Demolition Sign TYPE New R�—(Gas <br />� 'Sprinkler Repair/Maint. LlOiher <br />CITY OF EVEREfi LOCAI. SALES TAX CO�E IS 3105 <br />WORK DESCRIPTION ( n � ` I C � , �' �, � <br />� � `�.,'� ��.1 � '� � �_ ' . L <br />�� : � ��� � �� ��-�'�—� � � i ' <br />N0. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWcR <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTF!ES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVEf�IiER <br />SINK (SERVICE/BAPJtv10f'/ETC.) <br />OTHER <br />NO. I TYPE OF FIXTURE OF ITEhf <br />A/C — NHANDLING UNITS <br />_ FORCED AIR SYSTEAIS <br />_ HEAT PUMP <br />_ UNIT HEATERS <br />_ CLOTHES DRYER <br />__ RANGE HOOD <br />_ WATER HEATEH � <br />_ h1ETAL FIREPLACE/STOVE � <br />FIREPLACEINSERT <br />_ GAS FIREPLACE � � : <br />GAS RANGE <br />GAS PIPING <br />� =� � OTHERs,�jl � % �f' L�C�J <br />� <br />I HERE6Y CERITIFY THAT I HAVE READ AND EXAPdINED THIS APPLICATION AND KNOW THE SA61E TO BE TRUE AND CORRECT. ALL <br />PROVISIONS Or' W1^!S AND ORIOINACES GOVERNING THIS 1YPE OF WORK WILL BE COh1PLIE� �YITH WHETHEF SPECIFIED HEREIN OR <br />NOT. THE GFANTItJG OF A PER�d1T DOES NOT PRESUP,IE TO GIVE AUTHORIlY TO VIOI.ATE OR CANCEL THE PROVISIOP� Or' ANY OTHER <br />STATE OR IOCAL LAW REGUWTING CONSTRUCTION OR THE PERFORPdANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />ONlCJE� OF THIS PROPERTY TO PERFORht THE WORK FOR WHICH APPLICATION IS MADE AND I COPdPLY 4VITH THE STATE <br />r.riniraACTOf�S LAN!?1627�.FCNJ 9ND 256200 WAC. <br />�I <br />