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SI'�E ADDRESS <br />LOT NO. <br />i <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT,'NA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />BLOCK I TRACT <br />�'Qco � ��,d�. �� s <br />TENANTNAME <br />'(� C��a � �''� C' '�'� <br />WNTFtACTOR �L�L�S��N <br />�QVC-C��'�Si^'J <br />PHONE _ _. _ „ <br />sy,.� <br />PROPOSED USE OF BUILUING <br />GJPS �;v.� <br />S�0. <br />PARCEL TAX I.DI p <br /># <br />nuuRCJJ �.�r rnv��c ^ `�I <br />'�l Cea�e.z�o;a� o�. LaPo�\Ma Ca , as�/-a�i� <br />CONTACTFORPERMIT PHONE <br />�v�- �o�eReae� qoq-�a�-�93y <br />ADDRESS 21P CONTR. LICENSE # <br />� ��oog ��w�,a9 s q�ia�3 �'1�vtasno3 <br />`\OvN� <br />Building <br />PERMIT R COmbinaAOn <br />TYPE g Demolition <br />Sprinkler <br />CONTRACT PRICE OF WORK � 1`� � SO <br />WORK DESCRIPTION <br />�e�o�e c0.b<Ne�s �r�b� <br />\ o\�S 1J �I `� <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 />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />v eRaN , <br />RMechanical <br />Plumbing <br />D Sign <br />� <br />SC Ol� <br />Addition I HEATSOURCE <br />Alteralion R Electric <br />New �j Gas <br />Repair/Maint. U Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />(�e p\ace <br />C�ij 1 N eiS <br />W � t�� !V e iJ <br />ON �XiS�iN� <br />('o l�s \L'� <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />R,4NGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />?ROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING UF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE 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 THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />DEBIT & CREDIT �ARDS ARE NOT ACCEPTED <br />