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SITE AUDRESS <br />'�� 25 �• O�gY , <br />LEGA LOT NO. <br />DESC. <br />OWNER <br />Noi�DST120� <br />TENANTNAME <br />C� r�1C-2 o�v <br />CONTRACTOR <br />PHONE <br />W /�"Q�l�� <br />PROP03ED USE OF BUILDIdG <br />C���� <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />!\ D � I I��lx <br />P�RMIT APPLICATIO� <br />C17Y OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />vC. <br />BLOCK <br />3 <br />PARCEL TAX I.D. # <br />U��Sf?Oo�Gll <br />TRACT <br />� �5*"5-�- S 1�/ <br />CONTACT FOR PERMIT <br />� � �l�Zo3 <br />�DAN 1JC��Si�2UW1 <br />AUDRESS <br />Building Mechanical <br />PERMIT R Combination R Plumbing <br />7YPE Demolition � Sign <br />Sprinkler <br />f� 12 E rvA �L <br />NO. I TYPE OF FIXTURE OR I7EM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />IAVATORY (WAS!i BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTA�N <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICErBAR/MOP/ETC.) <br />OTHER <br />�-Gr M/ � ti.� I <br />���.tl'1�7.: '<— <br />� , .r � <br />21P <br />��5-c�yoCn -t�l/ <br />PHONE �]� <br />�{zs. J Z 1 7�k�5 <br />PHONE <br />Z5.32Z �B�S <br />CONTR. LICENSE A <br />Addilion <br />Altera6on <br />New <br />Repair/Malnt. <br />HEAT SOUF.L� <br />(7 ElecUic <br />B Gas <br />Othe� <br />CITY OF EVERETT LOCAL SALES TAX CODF IS 7705 <br />�CHANICAL <br />NO. I YYPE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />+ FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYtR <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPIACE <br />GAS RANGE <br />GAS PIPING <br />Ei(HAUST FAN <br />OTHER <br />I HEREBV CERITIFY THAT I HAVE READ AND EXAAIINED THIS APPLICAT10.'J AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL Bc COM1IPLIEO l'IITH',YHF.THER SPECIFIFD HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIIY TO VIOLATE OR CANCEL THE PROVISIpN OF ANY OTHER <br />STATE OR LOCAL LA6V REGULATING CONSTRUCTION OR THE PERFORMAN(,E OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WH!Cti APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br />CON TORS 18 7 RCIN AND 296200 WAC. <br />� <br />/ . n <br />.��r/��1�1 tf-��� l��r� e4- <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />