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IJ <br />I �� <br />„ <br />IU <br />SITE ADORESS <br />� <br />LEGA LOT N0. <br />DESC. <br />OWNER <br />ls.(^rl�"�'Lr_-�t' <br />TENANT NAME <br />CONTRACTOR <br />G C� � ('�TZT v <br />PMONE <br />y�s- �3 � <br />PROPOSED USE OF BU�I <br />P�RMIT APPLICATIQ'V <br />CITY OF EVERETT PERMIT SERV�CES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />PARCEL TAX I.D. M <br />� � �� 7 � <br />BLOCK TRACT <br />-�i- -9 <br />ADDRESS <br />� '.lrc /i'7��r �:�ir�/ <br />� I CONTA NCT AME <br />PHONE <br />M <br />7 <br />ADORESS ZIP CONTR. LICENSE M <br />i��' �c. �17�-Y �y"��^Sr gg�os �o�,cT�la�yc <br />CONTRACT PRICE OF WOHK <br />WORK DESCRIPTION <br />�T ���« fi <br />—� �� <br />PLUMBING <br />NO. I TYPE OF FlXTURE Ofl REM <br />WATER CLCSET <br />BATHTUB <br />LAVATORY (WASH BASI�I) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />D�SHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />ing Mechanical <br />PERMIT Combination � Plumbing <br />TYPE Demolidon Sign <br />Sprinkler <br />Additlon <br />WORK Alteration <br />TYPE <br />Repair/Maint. <br />HEATSOURCE <br />E�ectric <br />OMer <br />CfTY OF EVEREIT LOCAL SALES TAX CODE �5 3/05 <br />,�o� � 2 <br />NO. I TYPE OF FlXTURE 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 FIREPLACE/STOVE <br />FIREPLACE INSERT <br />i`,AS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />I HEREBY CERITIF1' THAT I HAVE REAO AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF fAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEiHER SPECIFIED HEREIN OR <br />YOT. THE GRANTINCa OF A PERMIT DOES NOT PpESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OF LOCAL WW REGUWTING CONSTRUCTION OR THE PERFOFMANCE OF CONSTRUCTION. THAT I AM AUTHORIZE� BY THE <br />OWNER OF� T�HI .PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AN� I COMPLY WITH THE STATE <br />CONTFACT-O95 1..1�W 18.27 RCW AND 296.200 WAC. <br />� <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />rL <br />