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P�RMIT APPLICATI�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-5810 — FAX 425-257-8857 <br />SITE ADDRESS <br />6oi s� Ev�acr' <br />LEGA LOT NO. <br />DESC. <br />OWNER <br />Rvt���son1 PRnPER <br />TENANTNAME <br />C,6gQ�L�R �CITLN� <br />pARCEL TAX I.D. # <br />Y�al.l. (.� �Z IBz8a5-3-o40 �on09 <br />BLOCK TRACT <br />s� i8 �B�I - R-5E <br />CONTflACTOR � <br />C�s�o�H 0� ���t 5�5" ? Aw,�,„� <br />PHONE <br />PfiOPOSE� USE OF BUILOING <br />C O vti9 tfLG IhL.. <br />soo sE E��rt �%�« l,� a y�A <br />CONTACTNAME <br />{1'J.�E l�L�v2n4J <br />ADORESS <br />'j Z3 ��+Tuck y ST <br />B-u��rG��'�v� /�7,4 9fizaS <br />Buiiding Mechanicat <br />PERMIT R Comhination R Plumbing <br />TYPE D Demolition R sign <br />L> Sprinkler <br />CONTRACT PRICE OF WORK �`7 B�Q � 0 a <br />4z5 35"3-61 <br />PHONE <br />;so)-� �s o <br />ZIP CONTR. LICENSE q <br />CvsTDD 50`I ZL6 <br />C�57"O D 50 (�(� <br />RAddition I HEATSOURCE <br />Alleralion � Electric <br />S New Gas <br />d RepaidMainl. Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCFiIPTION <br />rl����sr.ac.� ,�Ew c-ztz'r'2ica,L Stti�Js' <br />C4lt, oLb'SIL/fS A�E 2EU.�OVt�) <br />NO. I TYPE OF FIXTURE OR REM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 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 />NO. I TYPE OF FIXTURE OR ITEM <br />A/C —AlHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPIACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPIDlG <br />EXHAUSTFAN <br />OTHER <br />I FIEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROV�SIONS OF LAWS ANO ORI�INACES GOVERNING THIS TYPE OF WORK WILL BE COMPUED WITH WHEfHER SPECIFIED HEREIN OR <br />NOT. THE GRANTINCa OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW FEGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERN TO PERFORM THE WOFK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAnW 1827 nRC'W/AND 296.200 WAC. <br />�.` �t' � �I°�.c� _ 3- zs-c`�z <br />