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SITE ADDRESS <br />�/ lC <br />LEGAL LOTNO. <br />DESC. 7 <br />OWNER <br />���clC� �� , <br />TENANT NAME ' <br />CONTRACTOR �� /'/;� ,,, , <br />��� ��e/ <br />PHONE `v�C-�� ��/ <br />/ ✓ <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />P�RMIT APPLICATIGN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />�%�V�� PARCELTAXI.D.# <br />' '� -�57- � ,--. <br />BIOCK TRACT �1� � <br />/ �'�s� �� e/ j <br />ADDRESS <br />�?% �����1-������/ ,e ,�� <br />CONTACT FOR PERMIT <br />Ti��l� /��0�'���n <br />'�1��`: ( , .�I� r��:'�e .S'� <br />. E�t�n'� G�/1- 9�'2� <br />Building Mechanical <br />PERMI7 Combination F'umbing <br />7Ype Demolition Sign <br />Sprinkler <br />TYPE <br />�� <br />7 -- 30 --o y <br />PERMIT x <br />� yo(� � � � <br />PHONE LZ�—��II <br />T <br />�5�2� i/, <br />PHON� <br />'%��- ��L_ <br />, <br />CONTR. LICENSE p <br />G.9f�iVPZ"/O�i�3 <br />ditian <br />Alteralion <br />New <br />RepairlMaint. <br />HEATSOURCE <br />ctric <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />WORK�ESCRIPTION ^_�{._._'.,,,, /� ��.yyA/��L,'� ,�/p/�. p>//�7�J� �/�G'T(� <br />���'," Z'L�T // vKl� UI/L!� [i%V� / � f �� <br />( ' � � - <br />':l' � ' � '.� � �' ` - vl <br />rr,� r� �,�� �, ,r�,. <br />NO. � TYPC- OF FIXTURE Oft 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�VASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOPlE"i C.) <br />NO. I TYPE OF FIXTURE OR ITEM <br />NC — 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 FIREPIACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />_� OTHER <br />I HEREBY CERITIPY 7HAT I HAVE READ AND EXAAIWED THIS APPLICATION AND KNOW TFIE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIGIVS OF LAWS AND ORIDINACES �OVERNING THIS TYPE OF INORK \VILL BE COMPLIED WITH VJHETHER SPECIFIF_D HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOE� VOT PRESUM1IE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE FROVISION OF ANY OTHER <br />STATE OR LOCAL WW REGULATING CONSTRUCTION OR THE PERFORh1ANCE OF CONSTRUCTION. THAT I AM AUTHORiZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE 4VORK FOR NHICH APPLICATION IS h1ADE AND I COMPLY VJITH THE STATE <br />COIv iRHCiTORS LAW 'i�27 RC`Jy AND 290200 �YAC. <br />����1�� ii % n ii.�/�l� n/. /I.. n i1 <br />rizea Ngenc v��G I <br />DEBIT 8� CREDIT CARDS ARE NOT ACCEPTED '� <br />