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�'ERMIT APPLIC/�-;'�- .ON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> 10�2/ <br /> SITE ADDRESS -�.-tc:�*S#—^���rcJ, v<<<r W PARCEL TAX I.D.# PrRMIT a <br /> ��Y'iri ('JO'l OD I ��(�j�7� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AODRESS ZIP PHONE <br /> ?2„� t"�ac��f�c . �1`t��i3l ��<<rc �4r Wa <br /> (2�.�ta�� ��-rapf�„}�LS r v��re�tt , � �CSa-o3 [tia.$) Nb�-3.ao� <br /> TENANTNAME , CONTACTNAME <br /> PHONE <br /> ZVt� U� .��� I i���•,�-� CHaS) a�t- a333. <br /> CONTRACTOR ADORES3 ZIP CONTR.LICENSE p <br /> R�\�U fUL�-tti�S-v�C. �i��"SOU t�a�lpo�,- 1�Iac��,S��t'� s,o8 f�po��N� -pyy..� <br /> PHONE N�J���'�`LU, �A a A a'7S <br /> ���as) 3ti� � sd�4 <br /> PROPOS50 USE OF BUIL�ING � Building I-"1 Mechanical 11 qdtlition HEAT SOUACE <br /> �1r��1 i�� S 1 h PERMIT Combination 4� PlumCing WORK �_LAlteration Electrir, <br /> ��� ,� ���� � TYPe Demoiition �• <br /> ��45. 4.'��'. � )c,t Sign TYPE yQ New � � Gas <br /> Sprinkler 1..J FepaiNMaint. Other <br /> CONTRAC7 PRICE OF WORK � � cbop;" CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORKDESCRIPTIONS���zt� � S�'ti O� �4'���rSC'�ri�r'�o'�' �\�`V���v��"t4c�, <br /> , PLUMBING MECHANICAL <br /> � NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ WATERCLOSET _ A/C—A/HANDLINGUNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) __ HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK& DISPOSAL CLOTHES DRYER <br /> _ DISHWASHER _ RANGE HOOD <br /> � _ LAUNDRY TRAY _ WATER HEATER <br /> _ CLOTHES WASHER ' _ METAL FIREPLACE/STOVE <br /> _ URINAI _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS RANGE <br /> _ BACKFLOW PREVENTER _ GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.; _ EXHAUST FAN <br /> _ OTHER _ OTN�R <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMIIJED iHIS APPLICATION AND KNOW THE SAME TO BE TRUE AND COfiRECT. ALL <br /> PROVISIGNS OF LAWS AND ORIDINACcS GOVEFIJiNG THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfF!ER SPECIFIED H[REIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES PJOT PRESUh1E TO GIVE AUTHORITY TO VIOLAiE OR CANCEL THE PFOV�SION OF ANY 0T4ER <br /> STATE OR LOCAL LAW REGULATING f,ONSTRUCTIGV OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUT40RIZED BY THE <br /> OWNER OF THIS PROPERiY TO PERFORM TFIE WORK FOR WHICH APPLICATION IS MA�E AND I COMPLY WITH THE STATE <br />— CONT CTORS LAW 78.27 qCW AND 296200'..AC. <br /> a-�^^- 5-a-03 <br /> Signature ol Owner/Contra or/Authorized Agenl Date 1� <br /> �Z <br />