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� <br />F�.:RMIT APPLICATI�,N <br />CITY (.�F EVERETT PERMIT SERVICES <br />3200 CEDAR STHEET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-od57 <br />SITE ADDqESS <br />�l `(i0 E�e�,��eehl.i/�.Yi � <br />LOT NO. <br />��✓vo✓ � ��c <br />TENANT NAM1tE <br />, <br />w /� Tcc� �� <br />BLOCK <br />ri�Pj <br />PARCEL TAX I.D. q <br />� 3.�Y 09-3 0�) DOoa <br />TRACT <br />a�i�� 'bot� d %�v, fui�e /U3- L✓Cr, <br />CONTRACTO/R , y"-/�_ <br />TCIC(C! �/ �O Ni�l^. <br />PHONE <br />5�.�t� 337 ��3� <br />PROPOSED USE OF BUIL�ING <br />,/ � PERMIT <br />��ukYp NX'l�yJiOvi TYPE <br />CONTRACT PRICE OF WORK <br />G7 0 0 <br />CONTACTNAME <br />f�� <br />PERMIT # <br />!� D3o c.� - � O/ a— <br />s��s�asa-� 9ov <br />PHONE 7 �G � <br />�s y�� 73� �- <br />ADDRE53 ZIP CONTR. LICENSE N <br />s-�;�7 C��e�y��r,, w�.r 9.�a�s Ta�;Cr-��rPa <br />�Building � Mechanical <br />Combination Plumbing <br />Demolilion Sign <br />Sprinkler <br />WORK DESCRIPTION <br />� 0 x � 1� �u�,�yN �9�✓.�; oh <br />N0. � TYPE OF FIXTURE 7R ITEM <br />_ WATER CLOSET <br />BATHTUB <br />_ LAVATORY (WASH BASIN) <br />SHOWER <br />_ KITCHEN SINK 8 DISPOSAL <br />Y TRAY <br />S WASHER <br />URINAL <br />DRINKING UNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREV ' <br />SINK (SERVICEJBAR/D <br />Addition <br />WORK Alteratian <br />TYPE New <br />RepaidMaint. <br />HEATSOURCE <br />Electric <br />as <br />Other <br />CITY OF EVERETT LOCAL SALES TAX COOE 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 />CLOTHES DRYER <br />AANG[ HOOD <br />METAL <br />_ GAS FIREPLACE� <br />_ GAS RANGE � <br />GAS P�PING <br />_L EXHAUST FAN <br />OTHER <br />I HEREBY CEaITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AP1D KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAW;; ANO ORIDINACES GOVEFNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEiHER SPE�IFIED HEFEIN OR <br />PIOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY CTHER <br />5TATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE PERFOPMANCE OF CONSTRUCTION. THAT I AM AUTHCRIZEG BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MAOE AND I COMPLY WITH THE STA�E <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />�-,�r�ll�� i5��/o � <br />�L <br />