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� PERMIT APPLICAI ION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-6810 — FAX 425-257-8857 <br />S17E ADDRESS <br />Z8� S <br />LE6A LOTNO. <br />S�I,cvt.. I-�U��tC S <br />n PARCEL TAX I.D. A <br />f,+ts.,_ /t�2 <br />BLOCK TRACT <br />ADDRESS <br />2��� � AY.oix . <br />PERMIT i! <br />8z�1 �/1,f-3s�- �s" <br />TENANTNAME � CON7ACTFORPERMIT PHONE <br />- S„ %rc <ti��:,.r I l�'1%c,�(- l) «,�-z,i y7s- 3es- �s8s <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE / <br />����f- /-��,.�� It�z �z�,� � C�� 98zs8 <br />NHONe ' S}*.-.-� <br />425- 3iy- yll� <br />PROPOSED USE OF BUILDING <br />Building Mechanical <br />PERMIT Combinati0n R Plumbing <br />TYPE Demolition � Sign <br />Sprinkler <br />CONTRACT PRICE OF WORK � 5 Qp� . cv <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TO�LET) <br />BATIiTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DR,41N <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />� <br />Addition <br />Nteratlon <br />New <br />Repair/Maint. <br />HEATSOURCE <br />�Electric <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />�c hi�.��rc� C�(%U,GVL <br />�'�vt � rtc� � �.-..� <br />� Ti�U ! « �7J <br />.rTI�� �. �vsl <br />L�h/� <br />�/..c�+7 � irJ'l�l, <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — A/HANDL�NG UNITS <br />FORCED AIR SY'STEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND t!NOW THE SAM� TJ BE TRUE AND CORRECT. ALl <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED Wi � H WHETHER 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 IAW REGUTATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. . <br />/ Z /�S/ztG',J <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />