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SITE ADDRESS <br />bin� �I���., <br />LEGAL LOT MO. <br />DESC. <br />I��1 C.Y <br />TENANT NAME <br />� <br />P�r�MIT APPLICATIOi+I <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />PA�2CEL TAX I.D. # <br />BLOCK I TRACT <br />0�2 .�OC? <br />�. ; �P (��-r 6106 -�le,� � nw S�- 93'a� <br />CONTRACTOR 51 .�'� wC��S <br />6,n�E � I -I�BG(:U <br />�� <br />PROPOSED'' iF BUILDING <br />�i5; L�(i�CQ. <br />CONTRACT PRICE OF WORK <br />WORK DES�.'IPTION <br />NO. I TYPE OF fIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASriER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />CONTACT FOR PERMIT <br />1 ✓"'1 C� �'`�1 <br />'�ESS �%/�1 ���� <br />E,re,�e-rr <br />n Building Mechanical <br />PERMIT � Combination R Plumbing <br />TVPE Demolition � Sign <br />Sprinkler <br />�� <br />PERMIT # <br />D d �/�-oo� <br />K�S-5�a� ai��f <br />PHONE <br />uar-s��-����� <br />:ZIP CONTR. LICENSE # � <br />9g�°p S;-�ew�i a i d cd � <br />i <br />Addition <br />Altertion <br />New <br />RepaidMaint. <br />HEATSOURCE <br />Electric <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />NO. I TYPE OF FIXTUR[ OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAPdINED THIS APPLICATION AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORI�INACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED INITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERM!T COES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR C:INCEL THE FROVISION OF ANY OTHER <br />STATE OR LOCAL L�W REGULATING CONSTRUCTION OR THE PERFORh1ANCE OF CONSTRUCTION. THAT I Alvt AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR IVHICH APPLICATION IS MADE AND I COMPLY VJITH THE STATE <br />CONTRACTORS lAW 7827 RCW AND 296.200 WAC. �/� /O <br />��,�, � .��. y <br />Signature of Owner�Coniractor� uc orized ent Date <br />DEBIT & CREDIT CAFdS ARE NOT ACCEPTED <br />