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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br /><<%63-t�7� <br />SITE ADDRESS PARCEL TAX I.D. q P RMIT a <br />.3�1U /ii�G7JUG,4C�. �4-l'C. b0�2S-GY�I -D/ �) � lJ -�/ <br />LEGA LOT NO BLOCK TRACT <br />DESC. 4z-{-�(i.(1��� a� <br />f�os��u 1���J8/A/c C,o . 3�10� /i� � <br />TENANT NAME <br />CONTACTNAME <br />�LlSfi < � <br />f ( f�z� �v�iieit <br />PHONE <br />�Cu�� ira��-) �53-l0 27- 7yy� <br />CONTRACTORAI���,ILt�y��i�GN i,�,�L ADDRESS /�c �f�X �31 ZIP <br />�� ! (� <br />PHONE��J3'C!�77-7yy(� T'eICO/W]�Lii/� /b���D� <br />PROPOSED USE OF BUIL�ING <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />I,u��r�-�� vti� <br />, , <br />PERMIT <br />TYPE <br />n• <br />CONTR. LICENSE M <br />�Ii'�rc-�,.�i�n. 2�s <br />I"i Building f'� Mechanical Atldition HEAT SOURCE <br />F,� Combinalion �_� Plumbing WORK qlteration li Electric <br />�j Demolition pSt Sign TvaE New �_� cns <br />LJ Spnnkler (a o( heads) RepaidMninl. LJ Othcr <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 o'x i�� s� �= 1 NTe�V�t-t.�L y lL L U/1't //l�A T� (.UH-LC, S! <br />I D x 1 D= I CD �C�.1=-r. �.LELTI"<lG�L S/G/�/ <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEh7 <br />WATER CLOSET (TOILET) <br />enTHrue <br />LAVATORY (WASH BASIN) i <br />SI-iOWER ;� <br />KITCH[N SINK & DISPOSAL � ti <br />DISHWASHER ,,l � <br />LAUNDRY TRAY t, � � <br />CLOTHGS WASHER U - V' <br />URINAL � �` <br />DRINKING FOUNTAIN f���l�'� U� 1� <br />�LOOR DRAIN 1� <br />F3ACKFLOW PREVENTGR � "� /��� ��, � � <br />SINK (SERVICE/BAR/MOP/ETC.) II � (�• � <br />OTHER r� �) <br />-- �� <br />N0. � TYpE OF FIXTURE OR ITEM <br />wl;— Wt1ANULINCi UNITS <br />_ FORCED AIR SYSTEMS <br />_ HEAT PUMP <br />_ UNIT fiEATERS <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 />_ EXHAUST FAN <br />_ OTHER _ <br />--I I I <br />I HERE�Y CERITIFY THAT 1 HAVE READ AND [XA1d W[D THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRC-CT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL DE CO�dPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOL THE GRANTING OF A PER�dIT DOES NOT PRESUAIE TO GIVE AUTHORI7Y TO VIOLATE OR CANCEL THE PROVISION OF qNY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS,J'ROPERTY TO PE�iFORAt THE WORK FOR INHICH APPLICATION IS A4ADE AND I COAIPLY WITH THE S7ATE <br />CPNTRA��LAN�B �7 RCIAj�hl].2962Qp bVAC. <br />� <br />I/Z <br />