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SITE ADDRESS <br />'�? IU �/1L <br />LEGAL LOT � <br />� �el�'��a <br />TENANTNAME <br />�W ,' <br />CONTRACTOR ��,{ � (/ <br />w�c�- <br />PHONE <br />�.1 '�� -� , 7 <br />PROPOSED USE OF BUILDING <br />CONTRACT PR�CE OF WORK <br />FERMIT APPLICATIVN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />� �i V� <br />BLOCK <br />r''��� C1 � <br />TRACT <br />��h' a v� l�� <br />PARCEL TAX I.D. # <br />,57/ 7c>o/o/400 <br />�s��� 9�zs -�u �� <br />CONTACT FOR PERMIT PHONE <br />�-� i i L� (i:' ��;� . � � . `_'i � �'J -] - �j �' r .�- C ��: � . <br />,� �/lp�� ADDRE55 <br />CJU i72�1�i'��1,v <br />Building Mechanical <br />PERMIT Combinalion R Plumbing <br />TYPE Demolilion � Sign <br />Sprinkler <br />� <br />ZIp CONTR. LICENSE p <br />W+It�Tcrqg�J3 <br />Addition <br />WORK Alteration <br />TYPE IJew <br />RepairlMaint. <br />HEATSOURCE <br />Electri�; <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />WORK DESCRIPTION � . <br />�.-�� J �,,,�, /���o�,rn� c�� - 2 <br />���n,��i:, <br />NO. I TYPE OF FIXTURE OR ITEM <br />' WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />_ SINK (SERVICE/BAR/MOPlETC.) <br />�:- ;i.X <br />�' ���. � <br />G� <br />� <br />NO. I T1'FE 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 />OTIIER <br />^ -r <br />J / <br />v i� ' <br />i HEREBY CERITIFI' THAT I HAVE READ ANO EXAAtINED THIS APPL�CATION AND KNOW THE SAtv1E TO BE TRUE AN� CORRECT. ALL <br />PROVISIOhS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF N'ORK WILL BE COA1PlIED N9TH'aVHETHER SPECIFIED HEREIN OR <br />NOT. THE G�ANTING OF A PERA4IT DOES NOT PRESUME TO GIVE AUTHORIN TG VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAN� REGULATING CONSTRUCTION OR THE PERFORMANCE OF CO�STRUCTIOY. THAT I AM AUTHORIZeD BY THE <br />OWNER OF THiS PROPERTY TO FERFORId THE WORK FOR �VHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />Signature of Owner/Contractor/Authorized Agent �ate <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />' �a <br />