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S�TE ADDRESS <br />�� „ <br />J �' h C' y <br />LOT NO. � <br />I��i�vlCT.�' �� �%j <br />TENANT ME <br />PERMIT APPLICATION <br />CITY C1F EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETf, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />PARCEL TAX I.D. # <br />�'' � I L <br />BLOCK TRACT <br />� <br />i <br />;�G�(• C•�:,:�i�� r'� <br />CONTACT FOR PERMIT <br />%� <br />GC�f% r%J'� <br />PHONE <br />� I �2s .3o4-G�4 <br />CONTRACTOR ADDRESS 21P CONTR. LICENSE # <br />PHONE <br />PROPOSED USE OF BUILDING <br />� f ll,' l�- S L. <br />CONTRACT PRICE OF WORK <br />Building Mechanical <br />PERMIT Combination Plumbing <br />7YPE � Demolition Sign <br />Sprinkler <br />,� J D DJ. c'? C� <br />WORK DESCRIPTION <br />i� .. �/ t.� a nn� ,�T tttG F�' <br />"�.�i� J-�. <br />(;I.L�:� �K-<.C, � f��.� �! <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLO�V PREVENTE ; <br />SINK (SERVICEiBAR/MOP/ETCJ <br />Atldition <br />WORK Alteralion <br />TYPE New <br />RepairlMaint. <br />HEATSOURCE <br />�ElecVic <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />0 <br />��iC C��C/S/rtcO it)�'�- act..i _(..1'c�C'c,r� <br />Q� . <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 CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF INORK WILL BE COMPLIED WITH WMETHER SPECIPIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT COES NOT PRESUAfE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGUUITING CONSTRUCTION OR THE PERFORA1ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF iH15 PROPERTY TO PERFORM THE INORK FOR WHICH APPLICATION IS MADE AND I C�MPLY WITH THE STATE <br />CONTRACTORS lAW 78.27 RCW AND :96.200 WAC. <br />��G:. /l�'.�r'n�.� �/-Lp-��� <br />��Z� <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />