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SITE ADpRESS <br />LOT NO. <br />DESC. <br />P�RMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />BLOCK I TRACT <br />PARCEL TAX I.D. p <br />Cil <br />PERMIT # <br />z3 oa � � � `U5� <br />, �,y'1 TS) ��- us ��ct u> <br />►4LP,�—�i l_/�w aaa� c�ebou�al L AV _�z�� <br />TENANTNAME CONTACTFORPERMIT PHONE <br />(��-P�c^R--T" lJkw ITea�s�. orZ ,ebr-r�- C3t�o)lo��-Z000 <br />CONTRACTOR �- <br />Re;�ecQe lnut <br />PHONE /n � _ � <br />2('_J,1Si��c1-t�J/� ADDRESS �b�p9 Ketiik�Q:�C�'Ct. Z�P <br />R.eQa�r �-r�• �nohom��s�� , Wa-. <br />lo�og- � oo�l <br />PROPOSED USE OF BUILDING <br />�ia�,l� Fnr..,� <br />CONTRACT PRICE OF V <br />Building Mechanical <br />PERMIT Combination Plumbing <br />7YPe Demalition Sign <br />Sprinkler <br />TJS, OOO.�G <br />9 232.9 (o <br />CONTR. UCENSE # <br />Addition <br />Alteration <br />New <br />epairiMaint. <br />HEAT SOSIRCE <br />p� Electric <br />� � Gas <br />L> Other <br />CITY OF EVERETT LOCAL SALES T/U( CODE IS 3105 <br />WORK DESCRIPTION � <br />�i�e- (ZeSTUUR-,�-�-ia� : Tb T✓�CI� Ae. (Le- ���otC Shnc��{G.w� � <br />ro-�-'�euS i�n,�wc�l� i s����cj � inSu�,.i{iay� i jo�sis� CcLb�Ae'I7��i w�n�S � F�oo(L <br />CErlahwu��, u.����.. %e-Qa;n-lrr,q e,,�-ia� �-es�!�Ncc . <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATIiTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />�LOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (S6RVICEIBAR/MOP/ETC.) <br />OTHER <br />� <br />' <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PU�viP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GASRANGE <br />GAS PI�ING <br />EXHAUSTFAN <br />OTHER <br />�� <br />I HEREBY CERITIFY THAT I HAVE READ AN� EXA611NED THIS APPLICATION ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAN'S AND ORIDINACES GOVERNING THIS TYPE OF WORK FVILL BE COAIPLIED WITFIIVHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT OOES NOT PRESUhtE TO GIVE AUTHORITY TO VIOWTE OR CANCEL THE PROVISION OF ANV OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO P[RFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COAIPLY WITH THE STATE <br />CONTRACTORS WlN 18.27 RCW AN� 296.200 N'AC. <br />� �_ <br />Gf"Lf -1 <( l liv'?)?f--)i i--- �-/(o -L� c'� <br />cl.,,.�e��.�° r'n�.,�s �i��.,r� in���n..d��,� e..o�r n�m <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />