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P�MIi APPLICATId� <br />CITY OF EVERETT PEP.MIT SERVICES <br />3200 CED/�R STR.EET, EVERETT, WA 98201 <br />425-257-8i310 - FAX 425-257-8857 <br />SITE ADDRESS �(r,p5 S,t. U.�QI'gl` JHqI� �1�4_V PARCEL TAX I.D. # aERMiT x <br />tv��e�}; l�k., 98208 ' I il..� �-f�/�- FJ��f <br />LOT NO. <br />TENANT NAME <br />_(�^�.�v�na�'�- <br />CONTRACTOii <br />PHONE <br />�-3NU- <br />PROPOSED USE OF BUILDING <br />S�ore. <br />CONTRACT PRICE OF WORK <br />BLOCK � TRACT. <br />I.CONTACTFORPERMIT PHONE <br />���- �.�lSe1 20�-3y0-�I3o� <br />ADDRESS 2� I <br />s���� <br />Building � <br />PERMIT . � Combination <br />ivaE Demolition <br />Sprinkier <br />I� ZSO L <br />Mechanical <br />Plumbing <br />Sign <br />Fr�e <br />S ZIP CONTR. LICENSE # <br />' SA(VDE55240�20 <br />�P.tldition <br />Alteration <br />New <br />Repair/Maint. <br />HEATSOURCE <br />�Electric <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORKDESCRIPTION I��IL �� � p�-e _efi � n��r,� �'(�� <br />, IS Q reSSto✓� 5yS-��Qr1 �� Pc�,� P i��, <br />0, <br />NO. � TYPE OF FU(TURE OR ITEM <br />WATER C�OSEf (TOILEf) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER . <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICEIBAR/MOP/ETC.) <br />OTHERT_ <br />Lk <br />� 102 V.�-30p �;r� <br />��me�rc�c,.l ki-�-cl�en <br />NO.. � 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 />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS FL4NGe <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CcRITIFY 7HAT I HAVE READ AND EXNM�NED THIS APPLICATION AND KNOW THE SAMe TO 6E TRUE AND CORaECT. �ALL <br />Preovi5i0Ns Or uawS aND oRIDINACES GOVERNING THIS.TYPE OF WORK N�ILL 8E COMPLIED WITH WHETHER SPECIFIED HEREIN Gr? <br />NOT. THE GRANTING OF A PER(v11T DCES NOT PRESUIdE TO GIVE AUTNORITY 70 VIOLNTE OR CANCc! �i Hc PROI�ISION 0� ANY OTHEFi <br />STATE OR LOCAL LAW P,EGULATING CONSTRUCTION OR THE PERFORIhANCc OF CONSTRUCTION. T:1:}T I AIJ AUTHORIZED BY THE <br />,dNcrZ OF THIS PRO?= TY TO PeRFORfv1 TH� VdORK FOR WHICH APPLICATION IS f�4ADE AND I COIJ?LY INITH i Hc SiHTc <br />�NT CTORS LAl 18. 7 . ^.200 WAC. � , � ' � <br />� Il `�z <br />Sinnaturr n flwnor/ nmc.� n..o�� n,. . � <br />DEBIT � CRED(T CARDS ARE NOT ACCEPTEb <br />