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SITE AD�RESS <br />s5 r� 3 Ca ����� <br />LEGAL LOT NO. <br />DESC. <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />BLOGK I TRACT <br />PARCEL TAX I.D. iF <br />PERMIT ii <br />Cu y 0/ - D/ (� <br />rrncR Ruuneaa cm rn�nt <br />i�r�oL � Loc� � �T <br />L��GhCl,r.-1 l� NG/-fb�-�.. »G� CCI�J�� C:;,�%,Tii lt'A ��Y2U3 355-(,52� <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />CONTRACTOR <br />PHONE � �(-' �1- �'l�� <br />PROPOSED USE OF BUILDING <br />� r�rz a� [ L <br />ADDRESS <br />Building Mechanical <br />PERMIT B Combinalion R Plumbing <br />7YPE Demolilian p Sign <br />Sprinkler <br />ZIP CONTR. LICENSE # <br />WORK R <br />TYPE D <br />U <br />Addition HEAT SOURCE <br />Alteration Electnc <br />New Gas <br />Repair/Maint. Other <br />CONTRACT PRICE OF WORK `+'1. � CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />9 <br />WORKOESCRIPTION {^. /vrC✓� 3 /7T'i/1 Gc�£�l!//7�- ,��c'll/��IIC CtJlZ/�S �/7Lty l�rj I-/{'�tL�'L <br />J / <br />�V� f$, r t' - tv'. v� �. (? �teG'JY-ICsL � <br />, �ri-I- ��n r�ti/r«/t t {���stf- i- %cor, ti� <br />i'�75-�,�11 ✓�"C't's;c�i ���/tf�h� ih C�ll`�l <br />NO. � TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />ORINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />NO. I TYPE OF FI%TURE OR ITEM <br />A/C -A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUA1P <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGENOOD <br />WATER HEATER <br />METAI. FIREPLACE/STOVE <br />FIREPU�CE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBV CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO DE TRUE AND CORRECT. ALL <br />PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED N9TH WHE7HER SPECIFIED HEREIN OR <br />N07. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITI' TO VIOLP:fE OR CANCEL THE PROVISiON OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTIOIJ. THAT I AM AUTHORI'LED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR INHICH APPLICATION IS MADE AND I COMPIY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />Signature of OwnerfContractodAuthonzed Agent Date <br />DEBIT & CREDIT CARDS ARE NO7 ACCEPTED <br />