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SITE FlDDRESS <br />;�� � 3 <br />LEGAL LOT NO. <br />�ERMIT APPLICATIc)N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />�G�I�h h� <br />BLOCK <br />�L��ii1 Corso� <br />TENANTNAME <br />PARCEL TAX I.D. # <br />TRACT <br />�3 �orl�� n <br />CONTACT FOR PERMIT <br />PERMIT � <br />M o3��-��l�o <br />ZIp PHONE <br />� �z63 �v2s�3Yg-s�� <br />CONTRACTOR WJ�Sti���}'on WA'IPi IiP�iJP�S AODRESS g"7 �4 S��h O� N�- <br />PHONE 36� -_� � "3,(� L(2� <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />Building �} Mechanical <br />PERMIT Combination I--S Plumbing <br />7YpE Demolitian � Sign <br />Sprinkler <br />ZIP CONTR. LICENSE # <br />`+xl�v WAS�f1I j�F� �j8c� � <br />�Addition <br />Alteretion <br />New <br />RepairlMaint. <br />HEATSOURCE <br />�Electric <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7705 <br />WORK DESCRIPTION <br />2 y- 2 � E F, t�� t, J C iis w�t- •�. ��, �c <br />NO. � TYPE OF FIXTURE OR ITEM <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 />OTHER <br />NO. I NPE OF FIXTURE OR ITEM <br />A/C -A/HANDLING UNI75 <br />FORCED AIR SYSTEMS <br />HEATPUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GP.S FIREPLACE <br />GAS R.4NGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CER�TIFY THAT I FiAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL �E COM1IPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUAIE TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORA1ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER O� PROPERTV TO PERFORAI THE WORK FOR 4VHICH APPLICATION IS MACE AND I COMPLY WITH THE STATE <br />CO IR� S W � RC9�A'ND 296200 WAC. <br />% �� /0/3�0 � <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />