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,, _ <br />F�RMIT APPLICATIUN <br />CITY OF f;VERETT PERMIT SERVICES <br />32C0 GEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />\\ � 1 u U ; �N <br />LOT NO. BLOCK TRACT <br />TAX I.D. # <br />�ia i7e�c"7 <br />��aY� <br />� —13-O�j' i <br />i <br />�-,��—_ > � / i <br />PERhtIT # <br />i <br />ti U�O�' <br />� c�oua 'r a1������rL\C l`lUia-35 �ti,e S't.,` �L4�C�� '--IJ�S-iy3` l�ll$' <br />TENANTNAME 1 I CONTACTFORPERMIT PHONE <br />C�NTRACTGR � • ' � <br />y ���.�c�-E���,s�,L�c <br />PHONE <br />1-y� 1-gss�� �1J�5-��13-17i� <br />AODR�SS � • 21P CONT[2. LIOENSE N-�. <br />�ib7a- 3s�Pu�S� �a4-�`- �5c��- ' <br />� Po��z�ti?���.� � <br />• �� a r• • � <br />i <br />PROPOSEDUSEOF,BUILDING Buildi0g �dechanical � Ac�fition HEATSOURCE <br />�\�i�e .�� PERMIT Combination Plumhing WORK Alteration Electnc <br />J TYPE �emolition Sign TYPE �ew �as <br />jU��� c�Y�..� Sprinkle� RepaidMaiN. Other <br />CONTRACT PRICE OF WORK � `� CIN OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br />1 o�i Dot�• <br />WORK DESCRIPTION �, � ,�\, <br />C erc�-S�t�-cr1«� � �� �y-"ti�:0..: �'e"�,�.,.y-� JLa�1J�Ct�. � <br />f� �JiclJs-C� <br />� C✓ W f,�(¢.LLC.`� � �7 � <br />NO. I 7YPE OF FIXTURE OR ITEM <br />J_ <br />�_ <br />� <br />� <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR'MOP/ETC.) <br />OTHER <br />NO. I TYPE 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 />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFV THAT I HAVE READ AND EXAMiNED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL �I <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TVPE OF WORK'.VILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR � <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUM1tE TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PRCVISION OF ANY OTHER . <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI<"ED BY THE ', <br />OINNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MAOE AND I COMPLY WITH TNE STATE , <br />CCNTRACTORS LAW 18.27 RC'N ANO 296 �00 WAC. ��, <br />1 <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED ';��_ ,; �; 2 j �2 <br />