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R�RlIIiIT APPLICATION <br />CiTY OF EVERETT PEF�MIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRESS <br />� I �0 �� ����� � <br />LEGAL LOT NO. BLOCK <br />DESC. <br />OWNER <br />TENANTNAME <br />� ��UY�� ����, <br />CONTRACTOR ✓ <br />u"�-�J� S st�w�s ��c <br />PHONE `I,Zr��l� �OCC <br />7 5 <br />PROPOSED USE OF BUILDING <br />PARCEL TAX I.D. # <br />�RACT <br />CONTACTFORPERMIT <br />�ii►1 Lie�sUc� <br />ADDRE55 <br />1 `l ov CvE,r�C +��es� � ��� �E�r�N, <br />PERMIT <br />TYPE <br />CONTRACT PRICE OF WORI< G� ��/^� G� <br />✓ V <br />i <br />WORK DESCRIPTION <br />BBuilding <br />Ccmbinalion <br />U Demolition <br />U Sprinkler <br />Mechanical <br />Plumbing WORI <br />Sign TYPE <br />PERMIT � <br />PHONE <br />�vl� l�o�{ � � (c � <br />' ZIP CONTR. LICENSE # <br />����3 uuZ��S�t��-��� <br />Adtlition <br />Alteration <br />New <br />RepaidMaint. <br />HEATSOURCE <br />Flectric <br />Gas <br />Other <br />CIN OF EVERETT LOCAL SAI_ES TAX CODE IS 3105 <br />T�S��II -two v�o��-r�n �Xl��u� -��.5 <br />c�uc,t wo� (� <br />NO. � TYPE OF FIXTURE OR ITEM <br />� <br />� <br />� <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTtiES WASHER <br />URINAL <br />DRINKIIJG FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />G� I ��1 c`�SSac;� �r �-� <br />NO. I 7YPE OF FIXTURE OR ITEM <br />� <br />A/C—A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAI' PUtv1P <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WA'fER H[ATER <br />A4ETAL FIREPLACE/SiOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I NEREBY CERITIFY THAT I HAVE READ AND EXAAllNED THIS APPLICATION AND KNOW THE SAA1E TO BE TRU't AND CORRECT. ALL <br />PROVISiOtiS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WII_L BE COMPLIED'NITH WHETHER SPECIFIED NEREIN OR <br />NOT. THE GRANTING OF A PER671T OOE3 NOT PRESU6IE TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATIUG CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FJR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRAf`� ORS LA 78.27 W AN 296.200 W�`C. r�- <br />I'.7l �� n l ����,�1� �' aQ � J� � <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />