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SITEADDRES 6S'/� <br />� V[� Rc: � w�q <br />LOT �70. <br />I I KA i's <br />� PERMIT APPLICA'i ION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 – FAX 425-257-8857 <br />�aw47� Ri�4L-' �iP. <br />��8 zog <br />BLOCK TRACT <br />s�24 rz <br />sr�mNa rr, <br />PARCEL TAX I.D. # <br />oz�7 -7�'-S�Ut� <br />qBzqG �l�i-.�7b 6y�1 <br />TENANTNAME CONTACTFORPERMIT PHUNE <br />MiKi� , -DciGca�/ U�l�7'.. � , <br />P�ITRI'cty. jlu�/yn/✓ �i <br />CONTRACTOR ADDRESS 21P COf!TR. LICENSE # <br />Biil I�A�S S7zy l�s''/� r�� s c= <br />PHONE t�.z�� -� 7� d q�� SNc� ('�vr7�Sl7 �✓!9 q�'Z y6 . <br />PROPOSED USE OF BUILDING Building MeChanical ( Additlon HEAT SOURCE <br />�� �/c� PERMIT � Combinalion R Plumbing WORK � Alteralion � Electric <br />� TYPE DBm0litio� � Sign TYPE New Gas <br />Sprinkler Repair/Maint. Other <br />CONTRACT PRICE OF WORK � L�l��o p� p O CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />G�N✓�=R?' GQaa�s� Y'm s4 c�p,:�/ 1z�ry. <br />NO. I 7YPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />HATHTUB <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 />FLUOR DRAIN <br />BACKFLOW PREVENTER <br />_ SINK (SERVICE/BAR/MOPIETC.) <br />NO. I TYPE OP FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOGD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS R.4NGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APP_ICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED 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 OTNER <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 N'HICH APPLICATION IS MADE AND I COMPLY �VITH THE STATE <br />CONTRACTORS LAW '1827 RCW AND 296200 WAC. <br />C—Z O. �� � Z� ��' c7 �� <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />