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Pc�MIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />� <br />I <br />3200 CEDAR STREET, EVERETT, WA 98201 iQ/_�'.�7 <br />425-25'-8&10 - FAX 425-257-8857 P�-5 v� <br />CD 39��5=���d / 7G� -- <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT » � <br />'.r7�.�9_���...I.I�....r {\n�.�.c. no.. �,.��_na�a.-o3 � �DU/� <br />LOT NO. �� I BLOCK j TRACT <br />""� J ''-I I � I\ W�w w �..,, <br />OWNER ADDRESS 21P PHONE <br />�ct�t�2 r ���E ��S 1-L �c� a�'•':��v�SC ��411 9.iSL(v� "{a,5- i�13-iZ( <br />TENANT NAME CONTAC i FOR PERMIT PHONE <br />� � � 4�essi�...1 �las- 7�(3: 1715 � <br />� <br />-� <br />CONTRACTOR , ' ' � � � ADD SS �,�* ZIP CO,�r R. LI ISE # ' , � <br />A�'�lR- �V'��(J�tSt--si1_l.0 � l'lt�3a-3s �l��L- ��i'i�c5�-48�ta- HJA"i ,_ -�c3a�1 <br />-�y <br />PROPOSED USE OF BUIL�ING <br />S 1 i1��c.. �-c.rw \ <br />.:U11 G��fU.-�' <br />CONTRACT PRICE OF WORK <br />I�y Building rv-v��,��echanical <br />PERMIT 1I=�(_Combinalion ly'F'lumbing WORI <br />TYPE �..j Demolition � Sign TYPE <br />U Sprinkler <br />WORK DESCRIPTION <br />�� =-:_.� '� l r"' t�.' � ...,�:..��' ..:� c� e.� ca��' <br />�' J �`'' 1 <br />N0. � TYPE OF FIXTURE OR ITEM <br />_� WATER CLOSET (TOILET) <br />� BATHTUB <br />� LAVATORY (WASH BASIN) <br />� SHOWER <br />� KITCHEN SINK 3. OISPOSAL <br />� DISHWASHER <br />Lr1UNDRY TRAY <br />� CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />n Addition I HEA7 SOURCE <br />f-S Alteration Elechic <br />4K eN' s <br />LJ RepaidMaint Other <br />CI1Y OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />NO. � TYPE QF FIXTURE OR ITEM <br />A/C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACElSTOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />�ui � � A J ', -F ,..r. <br />-w;.. J�o,r-.�.c� <br />1 - C. _ �t .� Fo-..C.:.sw�'�) <br />I HEREBY CEFITIFY THAT I HAVE READ AND E,�AMINcD THIS :.PPLICATION AND KNO'N THE SAA7E TO BE TRUE AND CORRECT. ALL <br />I PROVISIONS Cr LAWS AN� ORIDINACES GOVERNING THIS TYPE OF WORK 1VILL BE COMPUED WITH 1VHETHER SPEGrIED HEREIN OR <br />NOT. THE GR:.NTING OP A PERAt1T DOES NOT PRESUh1E TO GNE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OF LOCAL LAW REGIILATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFOR�1 THE WORK FOR WHICH APPLICATION IS M14ADE AND I COMPLY WITH THE STATE <br />� CONTRACTC�2S LAW 76.27 RCW AND 296.200 WAC. <br />� � C� I I <br />RIZCtl H(JCfI[ vaw <br />DEBIT 8� CREDIT CARDS ARE NOT ACCEPTED '� I <br />��� 1���5 <br />