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SITE ADDRESS <br />�; ,1 r ��Y: <br />_EGAl lOTNO. <br />CESC <br />OWNER ` � C�L� Il,. fI <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEOAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />1 BLOCK TRACT <br />i ��UDRE <br />' S131. �%� <br />PARCEL TAX I.D. M <br />Cc� F���! �oi�co <br />�cY4ct ,7'�ruc.,��! <br />Tp <br />35`i-`�G53 <br />TENANT NAME LA !t,'E ICTI/ TL-C ;�i CONTALT FOR PERMIT PHONE <br />ywr�'C�1�.��l� �� ��L't C-�G���__ �l�15-�Z?-•�/�— <br />CONTiL1CTOR ��� AODRESS � ��� ���1 �r�;�, . r a�. 7JP CONTR. UCENSE 1 , <br />J`,, «� 1 ti�E <br />PMONE �iG-�"z�l.-I.i�C�l �ji�C�CC�cl�a �i�'/�5 ' <br />PROPOSEO USE OF BUILDING Bwlding ("� Mocnirna�l � AdCrton NEAT SOURCE �I <br />(�'r�'�=1(� w'/�i� �(,��Ct� PERMR Combmatan H PIumU�nc) WORK Meranon n Elactnc <br />TYPE Demd�tron LJ S�gn TYPE New . '�-i( Gis <br />SpnnM'^• I Repar�Ala�M. • LJ qhcr �, <br />CONTRACT VRICE OF WORK �� ,�y�� ` CITY OF EVERETT LOCAL SALES TAX CODE IS NOS <br />�" <br />WORKOESCRIPTqN .J�1lIl� �i�I�JT �L'r ��i�-�nCl�.� CG'F+CCCJ ��� ���.I o'' �i-�C<% , <br />C <br />f�la 1 fl J/C7l UlCC L LJ � l��Jl.( [i.��Q L�G'l'Y• <br />r�aiiwo�nv � �w��.nn� <br />NO. I TYPE OF FqRURE OR ITEM `•��� /Cw /„�C NO. I TYPE OP FU(7URE OR ITEM <br />I WATER ClOSE7 <br />BATHTUB <br />_J _ LAVATORY �YVASH BASIN) <br />_ SHOWER <br />KITCMEN SINK d DISPOSAL <br />� DISHWASHER <br />LAUNDRVTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKiNG FOUNTAIN <br />FLOOR DRAIN <br />BAGKFLOW PREVENTER <br />_ S�NK (SERVICFIBAR/p10P/ETC ) <br />OiHER <br />. A/C - /VHANDLING UNITS <br />_ FORCED AIR SYSTEMS <br />_ HEAT PUMP <br />__. UNITHGATLHS <br />CLO7HES DRYER <br />_ RANGEHOOD <br />WA f ER HEATER <br />METAL FIREPUICUSTOVE <br />FIR[PIAC[ INSERT <br />GAS FIREPV�CE <br />GAS RANGE <br />GAS PIPING <br />__ [XHAUSTFAN <br />OTHER <br />--I - - -----------_-... <br />�. MEREBV CERiTiFV THAT i MAVE RFAD AND EXAMMED THiS APPLICATION AND KNOW THE SNAE TO BE TRUElWD CORRECT. ALL <br />PROVt510N5 OF UVJS AHD ORiDiNACES GOVERNiNG THIS TYPE OF WOFK WILL 8E COMPLIED WITH WHETHER SPECIFIED NEREIN OR <br />YOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIOUITE OR CANCEL THE PROVISION OF ANV OTHER <br />� iATE Oii LOCAL lAW REGUTATMG CANSiRUCT10N OR THE PERFORMANCE OP CONSTRUCTION. TfiAT 1 FM AU iHORIZED BY TNE <br />1NNER OF THiS PRCWER7V 10 PF FORM THE WORK FOR WHiCH APPLICAiION IS MADE AND I COMPLV WITH !HE STATE <br />�OHTRACTORS UW iB 47 RCY! 700 WAC. <br />iii// ���/��� �1�1��b� <br />DEBIT 8 CREOIT CARDS ARE NOT ACCEPTED <br />