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F�ERMIT �4PPL�CATIVN <br />CI'fY Q�' EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, W,'. 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />LEGAL LOTNO. BLOCK <br />GESC.r <br />OWNER <br />� //` � <br />/ /(��/<'� /_-Y(l�/.� <br />TENANTNAME <br />�'�lv� SItW� <br />CONTRACTOR <br />PHONE �� <br />C����;� � <br />PROPOSED USE OF BUILDING <br />� <br />/ -2,��.. � _, <br />l� <br />CONTRACi PRICE OF WORK <br />WORK DESCRIPTION <br />PARCEL TAX I.D. !� <br />TRAC:T <br />ADDRESS <br />�� �� /7.'�G W. <br />CONTACT FOR PERMIT <br />ADURESS <br />� 3 ZIJ j � �'Z(.t, <br />Building Mechanical <br />PERMIT Combination R Plumbing <br />7YPE Demolitinn � Sign <br />Sprinkler <br />�(. ��'� �� 5����'e= <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATH7U8 <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTH[S WASHER <br />URItJAL <br />DRINKING FOUNTAIN <br />FLOOR DFAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />PERMIT # <br />� <br />yac-. dL3 � �i���4 <br />PHONE <br />ZIP CONTR. LICENSE # <br />Addition I HEAT SOURCE <br />WORK Alteratian Electric <br />TYPE New Gas <br />Repair/MainL Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 1105 <br />NO. i TYPE OF FIXTURE OR ITEM <br />A/C: — AlHANDLING UNITS <br />FORCED AIR SYSTEP�IS <br />HEAT PUN1P <br />UNIT HEATERS <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 />EXHAUSTFAN <br />OTHER <br />� i HEREBY CERI7IFY THAT I HAVE READ AND EXAMINED THIS APPLICATION A�D KNOW THE SAh4E TO BE TRUE AND rpRRECT. ALL <br />! PROVISIONS OFlAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COA4PLIED WITH WHETHER SPECIFIED HEREIN OR <br />� ^iBT. 7HE GRANTING OF A PERMIT DOES NOT PRESUMc TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORM1IANCE OF CONS7RUCTION. THAT I AM AUTHORIZED 8Y THE <br />OIN�!ER OF THIS PROPE�RTY TO PERFORM THE WORK FOR WHICH APPIICATION IS MADE AND I COMPLY Nlllli THE STATE <br />CONTRq� CTORS LAW 1827 S�W AND 296.200 WAC. <br />0 <br />!'0�/5 j�� <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />