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P'L,�MIT APPLlCATIL�J <br />CITY OF EVERETT PERMIT SEr�VICES <br />3200 CEDAR STREET, EVERETT, WA 9&201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />l� o `� L �` ,. d;: � <br />LEGA LOT NO. BLOCK <br />DESC. <br />TRACT <br />PARCEL TAX I.D. # <br />>q �,-00 I - <br />PERMIT q <br />�o�iic,�o-��a <br />�uere.�t I�uswc� �4-�,+��-r� 3►0� ���~I /�u� �i�aol '1aS-3o3-iiai <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />Sam� 3��� �,r���us tias'-sv�r-�5 y� <br />CONTAACTOq ADDRESS ZIP CONTR. LICENSE A <br />rzuPwTr'�vS�u(��i.r.+olJrTy 3�U�Colh•.� ;i,n �g�j01 <br />PHONE <br />'-i d-5 - 5 0 Y- t� 5`l a. <br />PROPOSED USE OF BUILOING <br />CONTRACT PRICE OF WORK <br />Building <br />PERMIT Combination <br />TYPE Demolition <br />Sprinkler <br />Plumbing <br />Sign <br />Adtlition <br />WORK eration <br />TYPE New <br />AepairlMaint. <br />HEATSOURCE <br />Electrc <br />Gas <br />Other <br />CITY OF EVFRETf LOCAL SALES TAX CODE IS 3105 <br />W6FK�ESCRIPTION �a�G�r/R���4....E P7��ST'InG �S•C�SlNC� <br />N0. I TYPE OF FIXTURE OR ITE�4 <br />WATER CLOSET <br />9ATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHE9 <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />_ FLOOR DRAIN <br />BACKFLOW PREVENTER <br />_ SINK (SERVICG�BAfl/MOP/ETC.) <br />N0. I TYFE OF FIXTURE OR ITEM <br />—�— <br />L <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEATPUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIFEPLACE INSERT <br />GAS FIREPIACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />I IiEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICF�TION AND KNOW THE SAM1tE TO BE TRUE AND CORFEC7. ALL <br />PRGVISIONS OF LAWS AND ORIDINAGES GQVEPNING iH15 NPE OF NORK 6VILL BE CO�dPLIED WITH �VHEfHER SPECIF'IED HEHEIN OR <br />'JL`T. THE GRANTING OF A PEPhiIT DO'c5 NOT PRESULIE TO GIVE AU7HORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />S'ATE UR IOCAL LAW REGUWTING CONSTFUCTION OR THE PEFFCFMANCE OF CONSTRUCTION. THAT I Abt AUTHORIZED 8Y THE <br />i.IVNER OF THIS PROPEi�TY TO PERFO"'d THE IVORK FCF IVHICH A?PLICATION IS �dADE AND I COPdPLY 1VITH THE STATE <br />�QVTRACTORS LACJ id.�; RCW AND 29d.2J0 WFC. <br />l/ <br />QEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />