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� t�ERMIT APPLICAl ION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />,�3ao �,,J 3ll - �� <br />SITE ADDRESYSA <br />� NI�I V�. � <br />LEGAL LOTNO. <br />DESC. �, 15 3 <br />OWNER <br />Fr�t Q��p C�rx.sn <br />0 <br />BLOCK TRACT <br />P�t�e <br />PARCEL TAX I.D. # <br />D iv i S� o r�. <br />PERMIT # <br />o ;i <br />TENANTNAME CONTACTFORPERMIT PHONE <br />rnc(ati.�c ����:1�. �l5sl�o2?�► <br />CONTRACTOR�,Y6,r��� ���ry����'RE�J 21P CONTR.UCENSEM <br />F� rst- �,}.n, <br />PHONE <br />PROPOSED USE OF BUILOING <br />51�'�j1t �uw.; l � <br />�Z�s, aer,cc <br />n� �5 ��hfX <br />Building Mechanical <br />PERMIT Combination R Plumbing <br />TYPE Demolition D Sign <br />Sprinkler <br />CONTRACT PRICE OF WORK � �C �, <br />WORK DESCR�PTION <br />N� ua�st�vct-�,.- � s�- <br />NO. I TYPE OF FIXTURE OR ITEM <br />� <br />.rr <br />C <br />0 <br />e <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 />�Addition <br />Alteration <br />New <br />RepaidMaint. <br />I�-�1�0 <br />HEATSOURCE <br />lectric <br />Gas <br />Other <br />CITY OP EVERET� LOCAL SALES TAX CODE IS �705 <br />r=ytlti.i �t.l {��J't(iPG.t'( <br />NO. I'IYPE OF FIXiURE OR ITEM <br />- � A/C-A/HANDLING UNITS <br />� FORCED AIR SYSTEMS <br />HEAT PUMP ' <br />UNIT HEATERS <br />� CLOTHES DRYER <br />� RANGEHOOD <br />L WATER HEATER <br />METAL FIREPLACE/STOVE <br />- FIREPLACE INSERT <br />- GAS FIREPLACE <br />^ GAS RANGE <br />GAS PIPING <br />� EXHAUST FAN �I� � <br />OTHER <br />:/ <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINEO THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LALVS AND ORIDINACES GOVERNING THIS.TYPE OF WORK WILL BE COMPLIED WITH WNETHER SPECIFIED HEREIN 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 CONSTRUCTI N OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO M THE R OR WH�CH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CON CTO LAW 18.27 RCW N 29 200 WA . <br />��. . <br />Signature of Owner Contractor u rize g Date �/ <br />Z <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />