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P`RMI'i AFPLICATIVN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVEREi-i, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE tiDDRESS <br />c?� - '� Oe . <br />LEGA LOT NO. BLOCK <br />DESC. <br />O W NER <br />�v���(/ %�nu i�'i�a. AUlfie�'i <br />TENANTNAME ' <br />PARCEL TAX I.D. k <br />5" -oo'- <br />TRACT <br />ADDRESS <br />� l 0.' Cc�//Sr�i AL e <br />CONTACT FOR P MIY <br />PHONE <br />s«��; e - i .s�� �, � ,�� � �-�_ 4i �s-- Sox - 65'/7 <br />CGONTRA�7CTO�F �l A��RESS 21P CONTR. LICENSE # <br />4'VEC�'1 rlJli�r1�G3 �V1'I.U�If^.1, .�IO�� �J��Ud QiVG �."'V� <br />PHONE � <br />`f ,�/; -SoY,"- G 5-/ � <br />PROPOSED USE OF BUILDING <br />PER�diT <br />TYPE <br />CONTRACT PRICE OF WORK <br />WORiCDESCRIPTION p� na�� � <br />�� � � �i/?'4!% <br />NO. I TYPE OF FIXTUR[ OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHQWER <br />� KITCHEN SINK & DISPOSAL <br />DISHWASFIER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKWG FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />Building <br />Combination <br />Demolition <br />Sprinkler <br />�vleChaniCal ��-�. rqddition HEAT SOURCE <br />Plumt�ing WORK �j Alteration R Electric <br />Sign TYPE �j New �f Gas <br />U RepaidMaint. U Other <br />CITY OF EVF.RETf LOCAL SALES TAX CUDE IS 3105 <br />���i/5�'ii j� Il � Si �C�f P� C e <br />N0. I TYPE OF FIXTURE OR REM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYST[MS <br />HEATPUMP <br />UNIT FiEATERS <br />1 CLOTHES DRYER <br />Z RANGEHOOD <br />� WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />�GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />: HEREBV CEHITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SA�dE TO BE TRUE AND CURflECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVEFNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIfIED HEREIPd OR <br />NOT. THE GRANTING OF A PER611T DOES NOT PFESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL I.AW RE�9ULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THA i I AM AUTHORIZED BY THE <br />OWNGR OF THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AN� I COMPLY WITH THE STATE <br />CONTFj(�CTORS LAW 18.2j RCW AND 296.200 WAC. <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTEQ <br />