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SITE ADDRESS <br />P�RMIT APPL�GATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVEP.ET"f, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />PARCEL TAX I.D. # <br />5U0 SC LvE�E'rt Mqc � <br />LEGA LOTNO. BLOC TRACT <br />DESC. 4 S�� I$ Z8 r1 � 2 S <br />PF,{tMl^ � D. / � I� <br />�1juY �'� <br />E✓e�e� , w,� 99�v8 �425) 353-� 40 0 <br />�n3��vscnt pnova'er�t-S SooSEE✓E.tc.T MP�� wAv�-irA'� <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />Ff�O iNA,•� l3�OTFiE2� DAv�O ito3i.VSOv �tZS�353-8q'Uc� <br />CONTRACTOR (jpel^%S� �MNMt�,•«w� ADDRESS ZIP <br />SCx� sE E vEV�Tf MA« wNY R"3- <br />PHONE(4ZS� 353-��j-OU �JC'c(LYt'C� V,/A SS20S <br />PROPOSED USE OF BUILDING <br />(ZGSTA.1cLAw � <br />pC'�=ICE�KE�A�I <br />�cBuilding Mechanical <br />PERMIT D Combination R Plumbing <br />TYPE Demoiition D Sign <br />B Sprinkler <br />CONTRACT PRICE OF WORK ,},{"3 vJJ. O O <br />e <br />CONTR. LICENSE # <br />Roa,NM�o�6oE <br />Addilion <br />WORK Alteration <br />TYPE New <br />RepaidMaint. <br />HEATSOURCE <br />Eleclric <br />Gas <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />WORK DESCRIPTION FR AV� E '�W O l3l�TH�OpJ�� S d' = 1.1 S� A« S i E�L C kl T PO e(� J tiI <br />�ri-�c �Sr�cK o� �3�a�D��vs �8- S�r�ss Sro�ti� r2�,.r ovoti i� ��zanr, �- <br />� 1-fOcro. �-rI A�s�: TF� �CJJ jH 2N 0 F co�� To 2oc�F Fu L Ft000 u¢ti ;. <br />N0. I TYPE OF FIXNRE OR ITEPA <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 />NO. . I T1'PE OF FIXTURE OR ITEM <br />A/C-A/HP,NDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIR[PLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. AlL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNIhG THIS TYPE OF WORK WILL BE COMFLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF 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 S�'ATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />� <br />DEBIT & CREDI T' CARDS ARE NOT ACCEPTED <br />