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PERMIT APPLICATI�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STRGET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS " <br />-l0 5�`` ��- <br />LE�.i LOT N0. BLOCK TRACT <br />OESC. <br />PARCEL TAX I.D. i{ <br />P RMIT # <br />�3C <br />� u, �. t���, �, ��.�s ��� /701 �sF� /��e. yis -3ss- �-�z <br />TENANT NAME CONTACT R PERMIT FHONE <br />,so51..�.u, l�ll�o.n �ZS -870 - 61zo <br />CONTRACTOR S 1 ��'�'��� ADDRESS �`-r0(i G��S ZIP CONTR. LICENSF 0 <br />� S\ � aE.CC7'r' <br />PHONE IZ� ^ 31 S"O%-1 � w0.� Ytiu'K��'�cyj Tr Z 75 <br />PROPOSEO USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />Building <br />PERMIT Combinatfon <br />TVPE Demolition <br />Sprinkler <br />RMechanical <br />Plumbing <br />D Sign <br />�Additlon HEAT:�OURCE <br />Nleratlon Eleclric <br />Naw Gas <br />Repalr/Malnt. Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />W D o� �Pr� ^ c.��i�c� —�c;� 6o�.c�ls — pl�wo — ► <br />� ��s�- ? <br />NO. � TYPE OF FIkTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LA'JATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES N'ASHER <br />URiNAL <br />DRINKING FOUNTAIN <br />FLCOR �RAIN <br />�ACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOPIETC.) <br />OTHEP. <br />N0. 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 />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBV fERITIFV THAT I HAVE READ AND E%AMINED THIS �.PPLICATION AND KNOW THE SAME TO �E TRUE ANO CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT FRESUME TO GIVE AUTHORIN TO VIOIATE OR CANCEL THE PROVISION OF ANV OTMER <br />STATE OR LOCAL LAW REGIiLATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. 7HAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERN TO PERfORM THE WORK FOR WHICN APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTi2ACTOR5IAW 18.27 RCW AND 296.200 WAC. <br />DE81T & CF2EDIT CARDS ARE NOT ACCEPTED <br />