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� � <br />PERMIT APPLICATION 8-i9-oy <br />CITY OF �VERETT PERMIT SERVICES LI ��1U5 GC'`7 <br />3200 CEDAR STREET, EVERETT', WA 98201 4L ' <br />425-257-8810 - FAX 425-257-8857 - ��� <br />SITE ADURESS <br />��731 tl�1flDKeAl7� Av� <br />LEGAL LOTNO. BLOCK <br />DESC. 2�� �' ��'J� <br />OWNER <br />MJtRK d� �Pf�J �3a�� <br />TENANTNAME <br />CONTRACTOR <br />PHONE „f�� <br />PROPO<ED USE OF BUILDING <br />/ // <br />CONTRACT PRICE OF WORK <br />PARCEL TAX I.D. 8 <br />DO�iO��odoo , <br />TRACT�yf �y <br />�'If L�Y�7 T1TJ��Of'I�% <br />�� <br /># <br />1331 M�M� ,Q.�/�. �t�Ra7'i ���,03 �{25. Zs�z. I !�o <br />ICONTACTFORP[RMIT <br />Building �] Mechanical <br />PERMIT Combinallon U Plumbing <br />TYPE Demolilion U Sign <br />Sprinkler <br />WORKDESCRIPTION �jMD(�(i7ON BF <br />n�►,rs-rR-��sni �F n�v s�, <br />NO. I TYPE OF FI%TURE OR ITEM <br />WATER CLOSET '�' I <br />BATHTUB i�' <br />LAVATORY (WASH 4ASIN) �I/,! <br />SHONIER <br />KITCHEN SINK 8 D�SPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKI�G FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREV[NTER <br />SINK (SERVICE/BAR/MOPlETC.) <br />OTHER <br />PHONE <br />ZIP CONTR.LICENSEM <br />�Adtlition <br />AI�a2tion <br />Now <br />RepaidMaint. <br />MEATSOURCE <br />Electric <br />Gas <br />o1Mr <br />CITY QF EVERETT LOCAL SALES TAX CODE IS 3105 <br />��o%lNr� �IAii�9L6" �R1M1�1%`� �6slY�n/%�.Tq-M� <br />� �PrYIAI(.�'1 IeC�ID6NC.� WIT� �2 57D�21s'SA�YJ <br />�s !� TWa GJlr2 C� 6�. /� OR75�9 ��IJKHs-O <br />u�n�H� �-- �gs'�( "s•�' G,�u��s sr <br />NO. I TYPE OF FI%TUIIE OR ITEM <br />AIC — A/FiANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING I„" <br />EXHAUST FAPI I�� � <br />OTHER <br />I HEREBV CERITIFY THAT I HAVE REAO AND E%AMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND COftRECT. ALL <br />PROVISIONS OF LAWS AND ORI�INACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHEft SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERh11T OOES NOT PRESUME TO C�IVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATINCa CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OW NER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 96200 WAC. <br />i,.�,� i� � 5/z�/�y <br />DEBIT & CREDIT CARDS ARE NOT AC�EPTED <br />� Z�' _"L��'i`% <br />t�2 <br />