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SITE ADDRESS <br />a���• �� <br />LEGAL LOT NO. <br />oEs�. , �.a <br />�ev,H�,i� d� <br />TENANTNAME <br />CONTRACTOR ��d, <br />P�t2MIT APPLICAT�ON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />I � /�k �V�ere�i V1a <br />BLOCK <br />44l <br />PHONE � GD- 6 51- o P6 8 <br />IPARCEL TAX I.D. t� <br />CJU4G15- i-14�-001-OG <br />TRACT <br />_a p,to� N,u ��� �;�h �1"0 <br />ADD ESS <br />» ��-;t,.�L.J�IE il�Y�vr�fe C <br />� <br />CONTACT FOR PERMIT � <br />QbOV� � <br />�IGh ADDRESS <br />�rao� ��•pc. NE� <br />YYIa`cy,.svi fle ,W�sh• <br />f�PR�OPOSED ULS,E OF BUI' DIN � Building � <br />LC1Y�O��S'1 $ 1N �C �qMl�� PERMIT Combinalion <br />� S � TYPE Demolition <br />�e5� �q�Y�� �6'� S � Sprinkler _ <br />W <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION �,e�UI JSI <br />�-� <br />th ov�e�c �'o builcl <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />IAVATORY (WASH BASIN) <br />SHOW ER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDHY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING fOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />RMechanical <br />Plumbing <br />� Sign <br />n <br />'�.iU �60-�51-0 <br />PHONE <br />ZIP CONTR. LICENSE # <br />qga�o ��mcorv*��a�o <br />n Addition <br />I-"1 Alteration <br />H New <br />LJ RepaidMainl. <br />HEATSOURCE I <br />�Electric <br />Gas IOther <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />q Sih�le F�,n,�� reS���,ce cV— aJ��t�Y �S��f: <br />q hew S1 hC��P �qln�)y YPS � dehca <br />c� <br />NO. I TYPE OF FIXTURE OR ITEM <br />� <br />A/C — WFiANDLING UNITS <br />FORCED AIR SYSTEMS <br />hEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPIACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERITIFV THAT I HAVE READ ANU EXAMINED TH�S APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. l�LL <br />PROVISIONS OF LA�VS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUAfE TO GIVE AUTHORITY TO VIOWTE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGUL�ITING CONSTRUCTION OR THE PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 8Y THE <br />OWNER OF THIS PROPERTY TO PERFORM TNE WORK FOR\NHICH APPLICATION IS IdADE AND I COMPLY WITH THE STATE <br />CONTRACTQRS LAW 18.27 RCW AND 296.200 WAC. <br />DEBIi & CREDIT CARDS ARE NOT ACCEPTED <br />