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P�RMIT APPLICATIUN - I <br />CITY OF EVERETT PERMIT SERVI(�ES <br />3200 CEDAR STREET, EVERE'rl', WA 98201 , <br />425-257-8810 — FAX 425-257-8857 � <br />SITE ADDRESS <br />� 3( �o�� �ve <br />LEGAL LOT NO. BLOCK <br />oesc. f(� � 1 ���1� � <br />OWNER <br />Gl� �� L��s��,� <br />TENANTNAME <br />� <br />CONTRACTOR <br />PHONE.�� CvI� P � — <br />PROPOSED USE OF BUILDING <br />5��,,1 � (��,,�,,'l <br />CONTRACT PRICE OF WORK <br />PARCEL TAX I.D. # <br />DU gjy-176U15 - <br />2ACT <br />�; , r Fy , 4��(d � �,� � , <br />9 3 ( ��lL <br />CONTACT FOR PERMIT <br />ADURESS <br />�ve <br />Building D Mechanical <br />PERMIT � Combination U Plumbing <br />TVPE Demolition U Sign <br />Sprinkler <br />PERMIT # <br />�',i-�^ ' <br />y���� ��s-�s9-� ��S <br />PHONE <br />ZIP CONTR. LICENSE �I <br />Addition I HEATSOURCE <br />WORK R Alleration n Elednc <br />TYPE ❑ New D Gas <br />u Repair/Maint. U Other <br />CITY OF EVEREIT LOCAL SALES TAX CO�E IS ]705 <br />WORK DESCRIPTION � 1i � O <br />k� �CGufj GfC�C�t�.�[., 17'7 X �-Il <br />f���L <br />NO. I TYPE OF FIXNRE OR ITEM <br />V��ATER CLOSET (TOILET) <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 DR41N <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 PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS F�REPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST F <br />OTHER — :��"C <br />I HEREBV CERITIFY THAT I HAVE READ AND [XAb71NEU THIS APPLICATION AND KNOIN THE SAME TO BE TRUE AN CORRE . ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS il'PE Of WORK WILL BE COMPLIED WITH WHETHER SP HERE�N OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGUTATiNG CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM l�UTMORIZED BY THE <br />OWNER OF THIS PROPERIY TO PERFORId THE WORK FOR WHICH APPLICATION IS �dADE AND I COMPLY WITH THE STATE <br />CONTRAGjOR�.,LA �.27 RCW AND�9�i.200 WHC. <br />� ��/� � � �\�v� <br />� /L <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />