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�cRMIT APPLICATIC�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SRE ADDRESS .� Q� n F 1 „� <br />J i 7 e.�twsZ <br />LOT N0. I BLOCK � TRACT <br />---'-M0.�1�i- �p,3'C� �J����'� <br />TENANTNAME <br />CONTRACTOR <br />PHONE <br />PROPOSED USE OF BUILDING <br />1�p SiC`J��` Vl PERMR <br />TYPE <br />CONTRACT PRICE OF WORK � lp OO <br />PARCEL TAX I.D. # PERMIT N <br />Iho3 v3-o35 <br />3909 F.�� �c <br />CONTACT FOR PERMIT <br />ADDRESS <br />Building <br />Combinatlon <br />Demolition <br />Sprinkler <br />RMechaNcal <br />Plumbing <br />D Sign <br />., <br />r <br />aP <br />HZS-Z5$-►�y0 <br />PHONE <br />CONTR. IJCENSE • <br />Addition <br />WORK Altextlon <br />TYPE New <br />RepslrMlalnt. <br />HEATSOURCE <br />D Electr� <br />(iea <br />Otlier <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J106 <br />WORKDESCRIPTION �����5 1�..� �{+i�� �..�.�c�. �� �.�l� <br />U . <br />CGO�^,rQ,yw_.o1 �ro-� .Q.�t��c 'i'v r'"`-� 1 <br />U �� � <br />N0. I TMP[ OF flXTURE OR REM <br />WATER CLOSET <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 DRAIN <br />BACKFLOW PREVENTER <br />SINK (SEflVICEIBAR/MOP/ETC.) <br />OTHER <br />S�.S l..s�- ���t�... <br />N0. I TYPE OF FlXTURE OR ITEM <br />A/C — A/HANDUNG UNITS <br />FORCED AIR SYSTEMS <br />HEATPUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANQE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />OAS FIREPLACE <br />GAS RANGE <br />GAS PIPINO <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE T';UE AND CARRECT. AU_ <br />PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPUED WITH WHEiHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUT110R�TY TO VIOLATE OFi CANCEL THE PROVISION OF ANY OTHER <br />STATE OFi LOCAL LAW REOULATINO CONSTRUCTION OR TYE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERN TO PERFORM THE WORK FOR WMICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACT F 827 RCW AND 298200 WAC. �/7 N� O� <br />!L <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />