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SITE ADDRESS <br />IS�lIT.[�7 <br />CONTRACTOR <br />PHONE <br />� .� n� !'� <br />PROPOSED USE OF BUILDING <br />[� / �%/1/�G <br />CONTRACT PRICE OF WORK <br />� � <br />PERMIT APPLICATIflN <br />CITY OF EVERETT PERMIT SERVICE� <br />3200 CEDAR STREET, EVERETT,INA 98201 <br />425-2E' &z10 - FAX 4?5-7_F7-8857 <br />PARCEL TAX I.D. tF <br />C. �o�� ooync�( <br />BLOCK TR;,CT r-� � <br />�/�o ,e � /""G, a i <br />HDDRESS <br />S% 1H r �� �� � ? <br />CONTACTFORPERMIT <br />� / <br />f��c .� �yl�/GI/./c, <br />• ADDRESS � <br />i ' <br />Iding Mechanical <br />PERMIT ombination R Plumbing <br />TYPE Dem01iti0n � Sign <br />Sprinkler <br />I � �.� _b5 <br />� <br />���a'"�r -9� <br />P MIT # <br />�.5i/ 3 <br />r��,CF <br />iONE y S,� — <br />i+il'��/ J_(O � <br />PHONE <br />�/.�i{- - �/ �(' - % �� 2 <br />ZIP CONTR.LICERSE#'� ' <br />. � . <br />/�Hi�%HG�.D ) O(3R� <br />Addition <br />WORK Alteration <br />TYPE ew <br />RepaidHtaint. <br />HEATSOURCE <br />EI ctric <br />Gas <br />Olher <br />CITY OF EVERETf LOCAL SALES TAX CODE IS 3105 <br />WORK OESCRIPTIOt� � J <br />'Y%FLI� �NSi /2UG.%/U�� � �Ny�rt /_'An,.�,y if-/J%�f'C <br />l <br />NO. I TYPE OF FIXTURE OR ITEM <br />� WATER CLOSET (TOILET) i/! <br />�BATHTUB !1 <br />LAVATORY (WASH BASIN) ( j/ � <br />� SHOWERf <br />I KITCHEN SINK & DISPOSAL <br />� DISHWASHER <br />� LAUNDRYTRAY� <br />7 CLOTHES WASHER + <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />NO. I NPE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />� FORCED AIR SYSTEMS 1 <br />HEAT PUMP <br />UNIT HEATERS <br />�_ CLOTHESDRYER! <br />1 Fv1NGE HOOD <br />�_ WATER HEATER � <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />�GAS FIREPLACE 1 <br />GAS RANGE <br />�_ GASPIPING �I�I <br />�_ EXHAUST FAN /� / �I I <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO PE TRUE AND CORRECT. AlL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING iHiS TYPE OF WORK WILL BE COMPLIED WITH bNHETHER SPECIfIED HEREIN OR <br />NOT. THE GRANTING OF A PERM11IT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR}�QCAL LAW R� NG C TRUCTION OR THE PERFORA1ANCc OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNEf�F TH15 PROP�RTY TO P R THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTiCACTARS L9W Yg 27 RCW A � WAC. . <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED ���s �,j :° <br />