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P���MIT APPLICATIG�J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRESS <br />�'�-� Lc�c�,T <br />LEGA ! OT N0. BLOCK <br />DESC. � <br />TRACT <br />PARCEL TAX I.D. # <br />'DO 1 — <br />/� `- oZD '—�% <br />PERMIT ri <br />m+ <br />ivere.Tr 4}e��s�uc� A4-�+��TY 3�0} ��a�l �v�. �t4aol 'iaS-3o3-iiai <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />5 a►� � I 3 � ��. c, R�r � us v�s'-.safr- � s y�-- <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE k <br />iuP}ei'1}vvs�u�, (-�i.r�{oO�Ty 31u4 Col�.t /}uc �S�1O1 <br />PHONE <br />tia-5 - 50� -V54a� <br />PROPOSED USE OF BUILDING Building echanical Addition HEAT SOURCE <br />PERMIT R Combination Plumbing WORK �eration � Electric <br />TYPE D Demolition Sign TVPE New Gas <br />S� R . U Sprinkler Repair/Maint. Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION Q�4 • r / R�e rv.c�Q.� �Pz �S T7 n G �S ��Q V�C � <br />( <br />N0. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHO W ER <br />KITCH[N SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SIPIK (SERVICEI6AR/MOP/ETC.) <br />_ OTHER <br />N0. I T'PE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />_ UNIT HEATERS <br />� CLOTHES DRYER <br />� RANGEHOOD <br />L_ WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />� GAS PIPING <br />5 EXHAUSTFAN <br />_ 7THER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNO�V THE SAME TO EF TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WOfiK WILL BE COMPLIE� WITH WHE7HER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOWTE OR CANCEL TI1E PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PEFFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPEFTY TG PEiiFORM THE WOFK FOF WHICH APPLICATION IS M1tADE ANO I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCLV AND 29fi.200 WAC. <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />