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P�RMIT APPLICATI�N <br />CITY OF EVERCTT PERMIT SERVICES <br />320G rEDAR STREET, EVERETT, WA 98201 <br />� V,(.N t} 1' �2.0 � � V �'/d �i ��,5-257-8810 - FAX 425-257-8857 <br />0 <br />SIT[ ADDRESS <br />�IIS Br6ad�u <br />LEGA � LOT NO. <br />DESC� <br />BLOCK <br />TRACT <br />PARCEL TAX I.D. # <br />P RMIT# <br />� �c�3.�.0 <br />W�lf�'I�Wr Muv'Nv <br />M WC � j' OI'� rVb L��Sn ��A/�' (�,. CONTACT FOR PERMIT PHONE <br />�� l � �L,�K, ��r�v ��-s�6'or—r53 � <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE # <br />Co f,�e�v C��.rn- l+auc�e 5 l ol al 3� �-v• 5•�. q g�v�r ��e1�off at o�2.J� <br />PHONE <br />�.i'�}:,r— J�l7�' �!7 .�� <br />PROPOSED USt OF BUILDING <br />v F� %e e <br />Building Mechanical <br />PERMIT B Combination R Plumbing <br />TYPE D Demolition p Sign <br />U Sprinkler <br />CONTRACT PRICE OF WORK ` q OO O <br />Addition <br />Alteration <br />New <br />RepaidMainl. <br />HEATSOURCE <br />ElecSric <br />Gas <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION ��x / i� a, r00�`CS W'�%h 1� I3' i'OT�4-� Q C� O IO 5�( r� <br />! S' �' n�K `� <br />NJ. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICEiBAR/MOP/ETC.) <br />OTHER <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C -A/HANDLING UNITS <br />� FORCED AIR SYSTEMS n U�� <br />HEAT PUMP �/ <br />UNIT HEATERS <br />CLOTH[S ORYER <br />RANGEHOOD <br />WAT�R HEATF.R <br />METAL FIREPLACE/STOVE <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS �IPING <br />EXHAUSTFAN <br />OTHER <br />i HEREBY CERITIFY THAT I HAVE READ AN� EY.AMW[D THIS P.PPL!CAiIpN AND KNOW THE SAME TO 8E TRUE ANU CORRECT. AI.L <br />PROVISIONS OF LAWS FND ORIDINACES GOVERNING THIS TYPB OF WORK WILL dE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />YQT. THE GRANTING OF A PERId1T DOE$ NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAVJ REGULAiING CONSTRUCTION OR THE PERFORA7ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM TNE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONT ' C�j' $�W 7_�ND 29� AC. � Jl �/O � <br />/.f � / � � <br />DEBIT 8 CREDIT CARDS .4RE NOT ACCEPTED <br />