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SITE A�DRESS <br />LOT NO. <br />DESC. <br />PE�2MIi APPLIC/�►TION <br />CITY OF EVERETT PERfVII f SERVICE i <br />3200 CEDAR STREE7', FVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8E57 <br />BLOCK I TRACT <br />PARCEL TAX I.D. # <br />— CYJ`/--d%8 — <br />PERMIT # <br />vr � M�'LC. � 7'�L sr �-,s,at� c.�a�, _ <br />TENANT NA1hc I CONTAG7 FOR PERMlT PHONE <br />�� T����� N� , a_ �q<o,� " NvkD.STPnM ti�s=:s3S `�'oZ9 <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE # <br />NnRl2STR.oK NF-A�'i,vb �. /��R, :�Nc (o,/I(v �/v7� PC- n�E Nd/�HA97�"kN <br />PROPOSED USE OF BUILDING <br />PERMIT � <br />TYPE <br />MS vC., w R `lBL�a <br />Buildiny �p4echanical <br />Comoination '(-S Plumbing <br />Demoiition � Sign <br />Sprinkler <br />Addition I NEA7 SOURCE <br />WORK �Alteration _ � Eiectric <br />lYP'e New � Gas <br />Repair/Maint . Other <br />CONTRACT PRICE OF WORK �� yvD CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />� <br />WORK DESCRIPTION <br />L/kF F�� LIKE. CNAn�occ� oF �%FT� 1°�;GkAGEO NFar-P�P <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 />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C—A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEA7' PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOUD <br />WATER NEATFR <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS kANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KPlOW ThiE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS. iYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES �OT PRESUME TO GIVE AUTHORITY TO �IOLATE 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 MADE AND I COMPLY WITH TIiE STATE <br />CONTRACTORS IF,W 18.27 RCW AND 296.200 WAC. <br />a�gnaturC�Contractorl�uthorized Agent � <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />