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SIT[ ADDRESS (,(fJ i <br />LEGA� � LOT O <br />DESC. <br />I��RMIT APPLICATI�N �'�`� ��� 7O� � <br />CITY OF EVERETT PERMIT SEF2VICES <br />3200 CEDAR STREE'I', EVERETT, WA 98201 <br />425 257-8810 - FAX 425-257-8857 <br />BLOCK <br />�� �; a i 2_ ����=.:�(1�u. �,� � V�.-C <br />TENANTNAME <br />CONTRACTOR <br />(���«,�Z C,1�,��a�X��,�.��. <br />PHONE �..11=>'-I�"l�-l�{�� <br />PROPOSE� USE OF BUILDING <br />S�r� jl� .l'-<.�,�,�•� <br />`.�c'.7 l ci� �%V\�� <br />PARCEL TAX I.�. # <br />TRACT <br />�–IU�a-'�J:i f'+J+t�� <br />CONTACT FOR PERMIT <br />l�.ya L.e:�51� <br />ADDRESS <br />��lo3;�a - 13J5��v'�S E <br />4>J�TV��2..� I <br />� uilding Mechanical <br />PERMIT �Combination �Plumbing <br />TVPE Demolition Sign <br />Sprinkler <br />CONTRACT PRICE OF WORK � v,� `; �� .' � <br />W'ORH DESCRIPTION <br />t�-��.�,: S ����yl� -��.����1� ReS�cSw�t- <br />PLUMBING <br />NO. I TYPE OF FIXTl1RE OR ITE�d <br />: I WATER CLOSET (TOILET) <br />�1 �BATHTUB <br />� LAVATORY �WASH BASIN) <br />SHOWER <br />� KITCHEN SINK & DISPOSAL <br />__� DISHIh'ASHER <br />LAUNCRV TRAY <br />__l_ CLOTHES 4^JASH[R <br />URINAL <br />DRINKING �OUNTAIN <br />—� FLOOR CRAIN <br />_I BACKFLOVJ PREVENTER <br />_�. SINK�SERV'C�-°ARrG4CP�ETC.) <br />__j CTHER___ <br />_� <br />G �al �os <br />� 'jC/> 'c�.Z <br />PERM1IIT tt <br />C�S.� ��aiti) <br />l3oN..�S:lqke,�� �-l�.a-,k3 <br />�71� <br />PHONE <br />y'a�J ' Z'-l3' 1 l l S� <br />ZIP CONTR. LICENSE # <br />�{`601�, f}-4iP1RE�U3?�-1 <br />Adtlihon HEA�SOURCE <br />WORK �Iteration �lectnc <br />TYPE ew as <br />RepairiMamt. Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS ]705 <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C - AJHANDLING UMTS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNI7 HEATERS <br />CLOTHESDRYER <br />RANGEHOOU <br />WATER MEATER <br />METAL FIREPLACE!STOVE <br />FIREPLACE INSERT <br />GAS FIREFLACE <br />GAS RANGE <br />GAS PiPING <br />EXHAUST FAN , <br />OTHER 111�c�v <br />,E�EOv CE�iTiFv rHn' i r.AVE RE.�D rnD E)wMINE� THIS MPUCaT10N,�ND KNO`�V?HE SAME TO BE TRUE FND CORRECT. a�� <br />-%C`t,SiGNS OF ls�lNS AND ORIDWACES GOVERNING THIS TYPE OF WORK L1'ILL BE CCMPUED WITH WHETHER SFECIFIED NEREIIJ OR <br />. r�,� �r�q�;TiNG Or .� ?ERI,!IT UOES NOT PRESUAtE TO GIVF AUTHORITY'0 VIOL1Te OR C:.NCEL THE PROVISION OF ANV OTHER <br />.,�'aTc 0° ! OCAL �At1' REGUL.ATING CONSTRUCTION OR TME PERFORIdANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />_ C: �:ER OF TniS ?ROPc"RTv'O PERFORM1I THE 4h'ORK FOR WH�CH APPLICATION IS MADE AND I COP.IPLY WITH THE STATE <br />_G.'v7RACTO�RS �:.lY 'B 27 RC1V AND 296:00'h'AC. _ <br />�- I '- .� /%�� <br />� '1 l J l-l'7i�� US <br />�, � �� <br />� ...............r, �.,o.,r.,.,� v„=�...n,�m� ,�,����n� — na�e <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />Yv <br />