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PCRMIT APPLICATIt�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRESS <br />�,zy �,1� ,4".�. <br />LEGAL LOTNO. BLOCK TRACT <br />DESC. <br />Rolo��-� L. ��1��ti> s)zs <br />TENANTNAME <br />PARCEL TAX I.D. # <br />CONTACT FOR PERMIT <br />�A��D L. �tuo� <br />CONTRACTOR " ADDRESS <br />ckw.:2� 1.�,i��.r..� Ei-,•1�7 <br />PHONE <br />� 1��1 9�o-or7 <br />ZIP PHONE <br />L..� �tOZ�� <br />PHONE <br />�lZ'> Zy 2 -Ola� <br />ZIP CONTR. LICENSE # <br />PROPOSED USE OP BUILDING Building q Mechanical AdtliUon HEAT SOURCE <br />PERMIT Combinalion-}�{/ Plumbing WORK R�S( Alteration Electnc <br />5.� �'L TYPE Demolilion U Sign TYPE �„j New � Gas <br />Sprinkler U RepaiqMaint. Other <br />CONTRACi PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 7705 <br />WORK DESCRIPTION • <br />C, �z� p,�;..� -C��� �P� -, ..w� �� ��.����.0 <br />Cj �"'SiALLAZ�.ni aF F2c'C= 57'•.,-,<<�� �fx� ��4Cd��cc <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISFOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />N0. I TYPE OF FIXTURE OR ITEM <br />Ei <br />� <br />A/C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPIACE/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 E:W�dINED 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 COMPLIED �4'ITH WHETHER SPECIPIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIOY OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORM1IANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF 7HIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LA�'J 1827 RCW AND 296.200 WAC. <br />lo�roJo3 <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />