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SITE ADDRESS <br />:,(,ll 5.�. , `L � <br />LEGAL LOT NO. <br />DESC. t.` <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDhR STREET, EVGRETT, WA 98?.01 <br />425-257-8810 - FAX 4?5-257-8857 <br />PARCEL Tl1X I.D. k <br />� �Ua� a�os,�bc�o3yoa� <br />BLOCK TRACT <br />G�l/\C.�C.��.� �U�nG��Ls �L� S.L. CJJ�CKc�I "ViII �L� �Z�V`C4�\ 1 U� V� <br />� <br />TENANTNAME <br />mi1a� shst.<.+�� <br />- Lcsuv� �fol cc�_ <br />CONTRACTOR <br />A���a� N��., ���. <br />PHONE� �`rS� 3��t^ S� <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />eF <br />CONTACT FOR PERMIT <br />1�'d�l '��Ftr;;c,.� <br />PERMIT # <br />�`�c <br />PHONE <br />(u�-S)3�i�t- S��y <br />ADDRESS ZIP <br />�`loo }{a�.kw�,- �\Z,z��Svi1t acr; /n�b��ltfo <br />H4 �i 8 �-�� <br />8uilding Mechanical <br />PERMIT B Combination R Plumbing <br />TYPE D Demolilion El{ Sign <br />U Sprinkler <br />CONTR. LICENSE k <br />Aaoc.�n.�l -�4ti-o� <br />Addition <br />Alleratiun <br />Ne,v <br />RepairlMainl. <br />HEATSOUFCE <br />�Electric <br />Gas <br />l:!her <br />CI1Y OF EVERETT LOCAL SqLES TAX CODE IS ]105 <br />WORKDE-SCRIPTION '1�STAII CI� fI�UbV�\'.n.'."�i.�� S}Ur`�'�vc+v�� SiJv\ <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DIS4WASHER <br />LAUNDRYTRAY <br />CLO?HES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />�LOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK �SERVICE/BAR/MOP/ETC.) <br />OTHER <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C —A/HANDLING UNITS <br />�ORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTI-iES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACEINS[RT <br />GAS FIREPLACE <br />GNSRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />! HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PRCVIBIJNS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WNETHER SPECIFIED HEREIN OR <br />NO�. THE GR4NTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOU+TE OR CANCEL THE PROVISION OF ANY GTHER <br />STATE GR LOCAL L1W REGULATING CONSTRUCTION OR THF 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 STATc <br />CONTRACTORS LAW 18.27 RCW AND 295.200 WAC. <br />Signature of OwnedContractorlAuthorized Agent Date �> � <br />DEBIT & CRE�IT CARDS ARE NOT ACCEPTED �/ <br />