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�E��1t11T APPLICAiIaN <br />CITti' �JF �V�RETi� PERl�iiT SERVICES <br />3200 CEDAR STREF_T, FVERETT, WA 98201 <br />='.25-257-FSp10 — FA:: 425-25?-8857 <br />��� G ------ -- - <br />SITE ADDRESS PARCtL'� AX t.??. # PERMiT # <br />,�` � rcvcr ,cc.�: c.ir i — -- �`� �� . �U� <br />— -- �1_._ .....---- -- <br />LEGA LOT NO, ELO^ TR�1�•�i� <br />IDESC. , _.._ _ ....__-- <br />OWNER AUfl�.ifSS:: � ZIP PHONE <br />TENANT NAME <br />tSL Zti <br />CONTf,C'i FOR PERMIT <br />, i3a.%'yi Sf��� pco�.�� <br />�:.rry Ne�.v co <br />PHONE �z5�- 7�G� S� �S' <br />� P.DDRESS <br />%�00 �i��r�i5o.(i ��i <br />�vcreF�FJ [vl `�6Z� 3 <br />PROPOSED USE OF BUILDING <br />PERMIT <br />��To �o�� TvaE <br />RBui�ding Mechanical <br />Combination Plumbing <br />D Demolition ign <br />!, Sprinkler <br />CONTRACT PRICE OF WORK $,�7 D� G(� ,3 �� <br />PHONE <br />= 776-8'�f ss' <br />ZIP CONTR. LICENSE # <br />RGrI�Nto %%CH. <br />�Addilion HEAT SOURCE <br />Alteralion � Elecltic <br />New Gas <br />RepairlMainl. Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORKO=SCRIPTION �uS�.�G C6� NL $iy„�S �l� L�f 5�5+I �/Vw'v -�'o���r <br />PLUMBING MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER 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 />r'LOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />NO. I?YPE OF FIXTURE OR ITEM <br />A!C—A�HPNDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HJOD <br />WAIER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLAC[ <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OfHER <br />I NEREPY CERITIFY THAT I HAVE READ AND EXAMIN[D THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TY?E 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 REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MA�E AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18. CW �C� <br />/ ,— 7, n[/ <br />�nzea Hgenc �a« � <br />I� <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTCD <br />