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SITE ADDRESS <br />LOT NO. <br />� <br />P RMIT APPLICATI�nI j��(���M <br />CITY OF EVERETT PERMIT SERVICES (I�i <br />3200 CEDAR STREET, EVERETi', WA 98201 ����'' � L�Ifit <br />425-257-8810 — FAX 425-257-8857 • <br />_ CITY OF EVFRF i <br />BLOCK I TRACT <br />PARCEL TAX I.D. # <br />�29 0030o i o0 <br />5 <br />EV�N-E� �-tio� D�S� �7ro C�f3Y AVE `�4zr�i� (n� <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />t-��„"� '� /AQcl�Sa� � 1'�W� <br />CONTRACTOR Tj���� ADDRESS �� `,r�y ��.0 ZIP CONTR.LICENSEp <br />-� > `,� <br />PHONE ��iZ�i7 �1� .�^`�����R"IgI� TJ�tj/'T��IIQS <br />PROPOSED USE OP BUILDING <br />CONTRACT PRICE OF WORK <br />I PERMlT R <br />TYPE D <br />U <br />(�%S 000 <br />WORK DESCRIPTION <br />✓ c � 5�+� <br />�V � ,c <br />P�uMsin <br />NO. I TYPE OF FIXTURE OR ITEM <br />�s�c N� <br />Bui�ding Mechanical <br />Com binalio n�Plumbing <br />Demolitian Sign <br />Sprinkler <br />QJ R� SOx <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH B,�SI�) <br />SHOWER <br />KITCHEN S�NK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAI' <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKF�OW PREVENTER <br />SINK �SERVICE/BAR/MOP/ETC.) <br />OTViER <br />�Addi�ion <br />AlleraD�n <br />New <br />RepaidMaint. <br />HEATSOURCE <br />ElecVic <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />5� o�c-`�T���n- D� rL nk� <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 />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS A{'PLICATiON AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING TNIS NPE OF WORK N'ILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERA7IT DOES NOT PRESUME TO GIVE AUTHORIIY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCT.ION OR THE PERFORMANCE OF CONSTRUCTION. THAT 1 Af`i AUTHORIZED BY THE <br />OWNER OF THIS PP,OPERTY TO PERFORM THE WORK FOR WHICH APPLICATIUN IS MADE AND � COMPLY WITH THE STATE <br />CONTRACTO�WIB2 C�2�6200WA`— <br />/ b •(o. .c�l <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />i�2, <br />