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N�RMIT A,PPLICAT`ivN <br />CITY OF EVER�1'T P�RMIT SERVICES <br />3200 CEDAR STRt=ET, EVERETT, WA 98201 <br />425-257-881 C -- FAX 425-257-8857 <br />SITE ADDRESS S u �Te C <br />iCJ� KD�Ic-1��10. <br />LEGA LOTNO. BLOCK <br />DESC. <br />WNER <br />ve LQ CovRs��. <br />TENANTNAME <br />5 u ��„i a <br />CONTRACT � <br />I � n� <br />PARCEL <br />OoS9 �� <br />TRACT <br />7 <br />CONTACT FOR PERMIT <br />ADO SS <br />(;evaN ►93ia �NNe2 <br />�a� GRaN.T¢ Falls , <br />PROPOSED USE OF BUILDING <br />'1le`J�0.0 �0./�l� <br />CONTRACT PRICE OF WORK <br /># <br />oo33ov <br />� Ou� <br />Wa <br />uilding Mechanicat <br />PERMIT Comb:nation � Plumbing <br />7YPE Demolii!on Sign <br />Sprinkler <br />P RMIT # <br />! ��3io -o�� <br />5 ZIP PHC1IiE q a s <br />�t S�sB <br />��. ?3�t-�a <br />FHONE <br />da�s�- <br />as8 � 43� <br />ZIP CONTR. LICENSE p <br />`i�*TSa- I.j�� .1��-,. x�� <br />TYPE <br />j� Addition <br />�"� Alteration <br />4-1 New <br />I.J Repair/Maint. <br />HEATSOURCE <br />ElecMc <br />Gas <br />Olher <br />CITY OF EVERETT LOCAL SALES TA7C CODE IS 7105 <br />WORK �ESCRIPTION <br />�-aNST2vcT�oN o� a o(ao�wa�/ —I"�rc�, anr ex�s'T� n�g 4�lQ.l,� <br />NO. I TYPE OF FIXTURE OR ITEM <br />1'VATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCIIEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />UR�NAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICEIBAR/MOPIETC.) <br />OTHER <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C -A/HANDLIN3 UNITu <br />FORCED AIR SYSTEMS <br />kEAT PUMP <br />UNiT HEATERS <br />CLOTHES DRY�R <br />RANGE HOOD <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 CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS.TYPE OF WORK WILL BE COMPIIED WITH INHETHER SPECIFIED HEREIN OR <br />NOT. THE GR.INTING GF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOL;TE OR CA�CFL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF TH�S PROPERTY TO FERFORA4 THE WORK FOR WHICH APPLICATION IS MADE AND I COIdPLY WITH THE STATE <br />CG.^lTRhCTORS LAW 18.27 RCW AND 296.200 WAC. <br />� � <br />s i <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />