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� ERMIT APPLICAT�uN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />a25-257-8810 - FAX a25-257-8857 <br />SITE ADDRESS ���y �T� D <br />_ �s! � 2.-1 `�-'—� <br />LOT NO <br />_ . —L— <br />oeC�iieF <br />A��4,� c,,.�.`p2,5�5 <br />TFtiANT NAh1F <br />re <br />CONTRACTOR <br />(-��ka�2 Cn-�ro-p��5`.y,��c. <br />PMONE <br />��3.5' �1�3'���� <br />VRCPOSEO USE OF BUILOING <br />�� 1 �l �I� .L �wl Iw` <br />1 <br />_ L:C}.IC�LWr� <br />PARCEL TAX I.D. q <br />UO � 7�/b -Q?p • ol b- 02 ANU <br />200 -au��- o!/ -oo <br />TRACT <br />(, ��9 -oS <br />pERt.tIT u <br />Pa.4+c 134_ <br />Y,C...�. �liti <br />l'lo?��.- 3•��A��.:iE rSa+t�.� yq;,iT....,,y�.s-'l-t3 ��i8 <br />CONTACT FGR PERMIT PHONE <br />�--�t��e.gSl� k�-$� -1�13- 1'I1$ <br />AOORESS ZIP CONTR. LIC:iNSE u <br />i�o3.1•3��AJc�C 9����, �1CHI2E�c 3�� � <br />I�:�Uwlding Me[hanical <br />PERMIT C�mbination �Plumbing <br />TVPE Demclition $ign <br />� Sprinkler <br />— — <br />CO�aTRACTPRICEOFWORK �L5' mCp, <br />irCRM. DESCRIP110N � <br />1:� z � � � n �1 e, �' ��� ��i �_i� <br />ACtliUon HEATSOURCE <br />WORK Atlerat:on �, ctc'r. <br />TYPE New � Gas <br />RepainMa�n; J Ctnr� <br />CIN OF EVERETT LOCAL SALES TAX COC)E IS 7105 <br />PLUMBING I MECHANICAL <br />NO TYPE OF FIXTURE OR ITEM <br />i _ WATER C�OSET (TOiLET) <br />\ BATHTUB <br />� j_ J,VAiCRY (14'ASH BASIN) <br />SNO'�h'ER <br />( KITChEN SINK 8 DISPOSAL <br />, �iSr+v;aSHER <br />�Al,'NDR� 'RAV <br />�� __�7tiE5 WASNER <br />�RiNnL <br />7RiNKitiG FOIJNTAIN <br />=�CCR LRAIN <br />B:.CKFLJ',h� PREVENTER <br />SiNK �SER�'ICE�BAR'MOP'ETC � <br />�?�ER <br />N0. � TYP� OF FIJ(TURE OR ITEM <br />0 <br />�� <br />�A <br />NC - FVHANDLING UNITS <br />FORCED AIR S1'STEMS <br />HEATPUMP <br />UNIT HEATERS <br />CLGTHES DRYER <br />RANGEHOGD <br />WATER HEATEF <br />METAL FIftEPLACE STCv"r <br />FIREFLACE �NSEnT <br />GAS FIREPLP.CE <br />GASRANGE <br />GAS PIPING <br />EkNAUST F:.N <br />OTHER IqiQc. <br />'E3� CE"^ ' F� 'r,qT � hAVE RE�1C AND EW1.I�NED THI$ APPLiCA710N AND KNON"ME SAM11E i0 BE TRUE .�'.J C:inRE=' <br />. 5�C^S C� .s.�VS:.NO ORiCN:.CES GOVERNu�G THIS TVPE OF V�'ORK �VILL BE COMPUED IN17M WHETHER S�EC��F E" �-O��y_ '. �- <br />'�•E 3F4�;T.VG C° 4�FR6H' L`OES NOT PRESUME TO GIVE AUTNQRITv TO VIOLS'E OR CANCEL'nE PRO':'��S'�GN G= -.� - <br />�;R _��'.��� _.:Y�: RE ,u'.AT�^�G CJP�STR�C'�ON OR 7ME PERfORMnNCE OF CONSTRUC'�CN THFT �:.rr qu7HCR Z_� �, �'-_ <br />._ '� S PROPER'� "C 'EQFOR.'d'rE �,VORK FOR WH!CN APPLiCAT10N i5 �dADE NND i ppM11PLv b�l'n '�c 5�"�'� <br />. . -^�_ .. r9_�f>��,�,.:n:i'�!C:J::.t('_ <br />�. : . :,•;�. --�,�_,�.�-- --- Sl i o,. <br />. . .. .� . �,.u,o ea . , eni �aia <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />l�Y <br />