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SITE ADDRESS <br />L� L LOT NO <br />D'cSC. <br />OWNER <br />�. � Nuc <br />TENANTNnME <br />sD� � �r. I 1.: <br />� <br />P MIT APPLICATIO�I <br />CITY OF EVERETT RERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />PARCEL TAX I.D. # <br />TRACT <br />,� ,� C "�O. i�o�c .Z 7'7 � <br />CONTACT FOR PERMIT <br />i.. !Je'�'�'`�/ I'�): ��-^i' <br />N����u^ r'�eG�n�Ji cnI �nC <br />PHONE c�2� tf20 • '7/6Y <br />PROPOSED USE OF BUILOING <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITF.M <br />L WATER CLOSET (TOILET) <br />BATHTUB <br />�_ LAVATOR7 (WASH BASIN) <br />SHOWER <br />KITCHEN SIiVK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />� FLOOR DRAIN <br />BACKFLOW PREVENTER <br />� SINK (SERVICF./BAR/MOP/ETC.) <br />OTHER <br />ADDRESS <br />/�f1y3 IOS��'n✓c_ N.1F- K'rIClaa� <br />�p� � �'oa V. <br />Building Mechanical <br />PERMIT � Combination �Plwnbing <br />7YPE Demolition Sign <br />Sprinkler <br />ZIP <br />PHONE <br />�/ZS- 23R- io g I <br />CONTR. LICEtiSE # <br />/�lil�e�"1 t l� k7�j <br />n Addilion <br />KAlteralion <br />�__� New <br />IJ Repair/Maint. <br />HEAT30URCE <br />Electric <br />Gas <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C—A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DP.YER <br />RANGEHOOD L �� <br />V�'ATER HEATER Z" "� "' <br />METAL FIREPLACE/STOVE <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />EXHAI,'ST FAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE. READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN 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 AUTHORIZED BY THE <br />OVJNER OF f3'PR�O�ERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE 5?ATE <br />CONT ORS LAW,�182712CW-AN� 29E.200 WAC. <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTE.D <br />