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FERMIT APPLICATfc�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SI7E ADDRESS <br />� I 2 C.o L�6`� h� � <br />LEGA LOTNO. BLOCK <br />oES�. 3y +�r i �c <br />OWNER <br />CotZv{ a- GF.NEar�rJ� '� <br />TENANT N <br />� 1►� <br />CONTRACTOR <br />PHONE O� �� <br />PROPOSED USE OF BUILDING <br />�r � <br />PARCEL TAX I.D. �f <br />00 3od� <br />TRACT <br />L�G r o r� �( rs�� <br />ADDRESS <br />oe-� 310 1+�r1i� <br />ICONTACT FOR PERMIT <br />�C1�R t+J '$ U R (r£ <br />ADDRESS <br />8uilding Mechanical <br />PERMIT Combination � Plumbing <br />TYPE Demolition U Sign <br />Sprinkler <br />CONTRACT PRICE OF WORK ;b . S"O QQ Q <br />l <br />PkRMIT # <br />/J <br />Q l...Q�/O -Gb <br />>'D lT � o r� <br />ZIP PHONE <br />R.D q82n3 QtS- ZS`t .< <br />PHONE <br />e.�s 34'i-4oua <br />ZIP <br />CONTR. LICENSE N <br />Additlon <br />WORK PJleraOon <br />TYPE New <br />Repair/Maint. <br />HEATSOURCE <br />�Electric <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 1105 <br />WORK DESCRIPTION ��O J� ,�X ��•.r �1-� �p �J' � 1 t�,.�QOC.�. �£(.�{' �'P�VM p �N(p , A�D <br />rfLC• <br />�✓ Ra 'B�� e.00r�l .1- ?,+'� BPrfN ¢c>o rn . I�JSTA u►J8� Et.E.cy F�-��'IB t�6� <br />►�N. ��-�,�w a�o.l -l.aT�¢��oR- Fr�lSH�S. ��T.��►��a w-,�a�o�a�, <br />NO. � TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILE'� <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <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 />NO.. I TYPE OF FI%TURE OR li; ;N <br />A!C—A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL �•IP.EPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />� HEREBY CERITIFY THAT i HAVE READ AND E%AMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF IAWS AND ORIDINACES GOVERNING TIi15 TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT FRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAI. LAW REGUTATIIJG CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF TIiIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTOR3'C1N 18.27_EtGYJ AN� 2Y6.200 WAU. � � <br />'a <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />