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SITE ADDRESS <br />1�61'1 HiG <br />[� <br />RMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />PARCEL TAX I.D. A <br />Av�,., E�r� ,. Ou5 (o3a 353 007 00 <br />I BLOCK <br />Shern �f O..rvfi <br />iTENANT NAME <br />�� Non� - v <br />�CONTRACTOR <br />�i tilOY�(.� <br />�PHONE <br />� 1�1 A <br />PROPOSED USE OF BUILDING <br />!) (�LE fANi�-Y Q.�hr <br />�,+c�.Q. ar Di�w� <br />PERMIT <br />�33-104--� P�aceSE <br />CONTACT FOR PERMIT <br />iGlvldcL�1 rnr Sherr� �c <br />ADDRESS <br />'�uilding n Mechanfcal <br />om na on ��'} Plumbfng <br />Demolition � Sign <br />Sprinkler <br />>� �ras 33�-�og3 <br />PHONE <br />S 3s�-a7g � <br />ZIP CONTR. LICENSE t <br />� ._---� <br />Additlon HEAT SOURCE <br />ratlon �c <br />New <br />Rapair/Maint Otl�er <br />CONTRACT PRICE OF WORK ��/�1� � I CITY OF EVERETT LOCAL SALES TAX CODE IS 3103 <br />Y! 0� <br />WORK DESCRIPTON • <br />'I�.e,rnocl�Q,.,u�-evibr' o�f l�9use,.�f ��e� l.ck�� in 1-,R, u�a( rno�ed �,uaQ,l u�. <br />beh�er,� a �.�- �t+�vn�s . -���,d�es, nt,�v SH.e�rodc . <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />IAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />NO. <br />TYPE OF FU(TURE OR ITEM <br />A/C—A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />W'ATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />� HEREBY CER�TIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISION: OF LAIYS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WFiETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUtdE TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRAC70RS LAW 1827 RCW AND 296200 WAC. <br />��L <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />