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SITE ADDRESS <br />IEGAL LO� O <br />DESC. '� � r , <br />PEr2MIT APPLICATIOnI <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />PARCEL TAX I.D. # P i <br />ve. o0 388- 3y- o�l-� <br />BLOCK TRACT �i �� <br />�4 EvQrrtl �►u�5�ort U Uol 7 <br />—(70Y <br />`i�c•'�'r���a �SSer'� ll�2a Rcnlu- �,►� 9�dDl �S�-1o543 <br />TENANTNAME CONTACTFORPERMIT PHONE <br />��►-���k i��s s�rf YY1,�ke I.�.fs� Ha.s- 3a�� a S3 5 <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE # <br />L.c�rscn �'on� l�8�5 4�' P�. s� S��t� g8a90 <br />PHONE <br />�z5- 3a�-as3s �R���� � iol DH <br />PROPOSED USE OF BUILDING <br />iC1S IG��r� <br />PERMIT � <br />TYPE <br />CONTRACT PRICE OF WORK ��7 O Z�'� oO <br />1 O <br />WORK DESCRIPTION <br />i�e mur�1 e � <br />NO. <br />TYPE OF FI%TURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DI;;HWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />�RINKING FOUNTAIV <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAFJhiOP/ETC.) <br />OTHER <br />Building � Mechanical <br />Combinalion Plumbing <br />Demolition Sign <br />Sprinkler <br />13 a�-�.ro o �„ <br />Addition HEAT SOURCE <br />WORK � Alteralion � Electric <br />TYPE New Gas <br />RepairlMaint. Olhe� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <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 FIREPLAC[ <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBV CERITIFY THAT I HAVE READ AND EXAMINE� THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF 1NORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIIJ OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORM1IANCE OP CONSTRUCTION. THAT I Ah1 AUTHORIZED BY 7HE <br />OWNER OF THIS PROPERTY TO PERFORh1 THE 1VORK FOF WHICH APPLICATION IS h1ADE AND I COMPLY WI fH THE STATE <br />CONTRACTORS LPW 18.27 RCW AND 29o".20G WAC. <br />9 -/S-a y <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />�� <br />z <br />