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SITE ADDRESS <br />(�i'�; ;,' r,�;,-; �� <br />LEGAL LOT NO. :;; — •� � � <br />DESC. j ,!`��.�tJ. ' - <br />OWNER <br /><': '„ -. .'' %�'/ , <br />TENANTNAME <br />. � <br />,.�In.It <br />PERMIT APPLICATION <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. # <br />, ., �o�o�-,-acr+-oc4-o`�. <br />BLOCK TRACT �/ p <br />�I�f�; j�"f'6 �El.'�';I„'i TPr�C� �T�7• <br />��-�1./ n,,i:: <br />CONTRACTOR �-r'r��: �i'- - <br />C-'l�(�/�Ir''� F_- <br />p40NE <br />PROPOSED USE OF BUILDING <br />l4�Z� �'�uKlL7`, ��LdlJ <br />CONTACT FOR PERMIT <br />SRME �ICv2.T, <br />ADORESS <br />Building Mechanical <br />PEttM17 � Combination R Plumbing <br />7YPE Demolitian p Sign <br />Sprinkler <br />PE MIT <br />� L <br />) <br />ZIP PHONE <br />96`,� a3 =�. s <br />�•HONE <br />/�� �o Jc= <br />ZIP CONTR. LICENSE # <br />�Addition HEATSOURCE <br />AlteraUon � Eleclnc <br />New Gas <br />Repair/Maint. Other <br />CONTRACT PRICE OF WORK „� � �� n^ I CITY OF EVERETT LOCAL SALES TAX CODE IS �105 <br />E.l v.�CYYI• <br />;�•,r.k�r-nci�1 r'Ac �E z cr_ rc <���,L Mo [.y5. Puc+,7�c� AE'rA��� <br />WORKDESCRIPTION '. F.r-�Y'� tU Tl� � 11X�t'nolJ i,e.�p JF 'TYP� O i GE�U/JG �CA��.1 i�CrF��- ).. <br />�, ,,,/ �r ,�; ,, �; ,c �r P.ctAr,t � NC„I c_rlrw 1�i <�� k S AIdO pEl'Ail.. �Q AOTi1ci N7 I�JrMn :.J <br />l.- ..,, . . , , .. ;i � '! �' ��cA5S��8 Er.rrP�t c.zntt To H�vE Rc'JE2bBo s4d�r���, i.>�r+.:'<7'r�AJ� <br />n <br />ij,,�.,�. r,<'.� t_ ilYE,i��A� (�:G(Cujti�j� Tg Fk�f:i� gt, H�[.H IzAiL FT�' COGF� , <br />... ��...,.u.. MFCNANICAI <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />6ATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & 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 />N0. I TYPE OF FIXTURE OR ITEM <br />� <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 FIREPXACE/STOV <br />GAS <br />GAS <br />FAN <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 N'ORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERM1IIT DOES NOT PRES�;i�1E 70 GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTIO�� OR THE PERPORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZE� 8Y THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR 1NHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACSORS LAW 18.27 RCW AND 296.200 WAC. <br />G% <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />Ilv <br />