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PERMIT AP�LICATlON <br />CITY OF EVEF��TT PERMIT S�RVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS n <br />�• — C L� � /�d ��^ <br />LFGAL LOT NO. BLOCK <br />DESC. <br />OWNER <br />�/l LX�I /� S Z i-, c <br />TENANT NAME <br />PHONE <br />PROPOSED USE OF BUILDING <br />N97 u �ii TP/'1I r4rli <br />CONTRACT PRICE OF <br />�,. PARCEL TAX I.D. # <br />� <br />TRACT <br />�oU7 - l�0oc/ii/d�/ <br />I CONTACT FOR PERMIT <br />`UhS��k��/�? <br />3 <br />��p � S' j �� =Y �$'t zi <br />� P/9- <br />Building Mechanical <br />PERMIT Combinalion � Plu�nbing <br />7YPE Demolition Sign <br />Sprinkler <br />WORK DESCRIPTION � „/r � �q �/ <br />���G f L4 <br />�lU <br />NO. � TYPE OF FIXTURE OR ITEM <br />WATEft CLOSET (TOILE i ) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />PERMIT # <br />r„�nt y2S3SP-ai�7 <br />. // �� <br />/�Dod,�v, / /� <br />PHONE CJ �O ) Z <br />�G-3 9 /- � //� <br />P CONTR. LICENSE # <br />f/�scoL*ooao� <br />Addition <br />irC:2K Alteralion <br />TYPE New <br />Repair/Maint. <br />HEAT SOl1RCE <br />Electric <br />Gas <br />Other <br />CITY OF EVEREiT LOCAL SALES TAX CODE IS 3105 <br />�, W i9 �� �f � f-/9 �� - <br />NO. ! TYPE OP FIXTURE OR ITEM <br />A/C -A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT �7EATERS <br />CLOTHES DRYER <br />RANGL HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />ti/J <br />i HEREBV CERITIFY THAT I HAVE READ AND EXAM!NED THIS APPLICATIOV AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWP. AND ORIDINACES GOVERNING THIS.TYPE OF WOP.K N�ILL Bc COMPLIED WITH'NHETHER SPECIFIED HEREIN OR <br />NOT. THG GRANTING OF A PCRMIT DOES NOT PRESUtitE TO GIV'c AUTHORITY TO VIOLATE OR CANCEL THE P�OVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />ONlNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 29'0.200 WAC. i , <br />% <br />3;�U <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />