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P�RMIT l�QPLICATI(�N <br />CITY OF EVERETT PERMIT SE�tVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRESS PARCEL TAX I.D. # P RMi7 tt � <br />� 00`F ''�'7 S7 Z 1 00�1�0 ' b - � <br />3uiS w. n�1R-w� ���J D�. � <br />I LEGA LOTNO. � BLOCK TRACT <br />' oesc. r� �,v�L�io 7Zi r�.zt--r'-i, �Orv N v2� zsi-3�'eI <br />� OWNER ADDRESS ZIP P ONE �8,�! <br />J��;�� S�Mi���u-1, ,MqRG1x�-5- Bp-,�liA�uo��c,�/,1n�s�t �6 ii C��� <br />� TENANTNAME CONTACTFORPERMIT PHONE <br />� u�oc�uPi �1D P.� Si��s �v2f) 303 -o8'y`� <br />� CONTRACTOR 21P CONTR. LICENSE # <br />i Arw2�A8�E /�'f��1c^�;�1R9�ess 373Z SU�r 8 9b2o� /}f'r��Rl IoGCF <br />� PHONE i �' Z�) 7� ��-l�jD7 Z <br />\ �56��=5,7'i Cz2T. Ca�.-j'YheZd-�f' �l U79� <br />I� PROPOSED USE OF BUILDING <br />•, ,� S�=u Ws Y� B�,u�a2 <br />' �,�,a «,,�. a.:� � a„A��r o�L <br />I-t�i a�t�z <br />CONTRACT PRICE OF WORK <br />�}�OrTc`� k'piT-�C-M�wf-* <br />Building Mechanical Addition HEATSOURCE <br />PERMIT � Combination � Plumbing WORK R Alteration [� Electric <br />TYPE Demolition Sign TYPE R New U Gas <br />Sprinkler v Repair/Maint. D Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />o� Dcr10 �V� _ <br />I WORK OESCRIPTION <br />�;/�=��7v� IZc�Mv�fiC._ pt� <br />I O C7YlOU TIO N�-� Iid ✓.�E , <br />N0. I TYPE OF FIXTURE QR ITEM <br />�WATER CLOSET (TOILET) <br />BATHTUB <br />I � LAVATORY (WASH BASIN) <br />SFiOW E R <br />_L KITCaEN SItJK 8 DISPOSAL <br />DISHWASHER <br />'�, �P,UNDRY TRAY��.., <br />CLOTHES WA.iHEft� <br />URINAL <br />DRINKING FOUNTAIN <br />i FLO: ,� DRAIN <br />' BACKFLOW PREVENTER . <br />SINK (SERVICE/BAR/MOPIETC.) <br />OTHER <br />{�sF�,o- I�� Su�vr i a' 7-S -03 <br />-�oJ.�-6,T11�'� A�0 GA. S �� SrOC"1Uk,-�$ <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />WEAT PUMP <br />CLOTt��S DRYER <br />RANGE F10�D <br />WATER HEA R <br />METAL FIREPLA /STOVE <br />FIREPLACE INSER <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFV THAT I HAVE READ AND EXAM11INED THIS HPPLICATION AND KNOW THE SAME TO BE'RUE AND CORRECT. ALL <br />PROVISIONS OF.�AND ORiDINACE^-'GOVERNING THIS TYPE OF VJORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRAN � ING F A PERMIT D S NOl'PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROV�SION OF ANY OTHER <br />STATE OR LOCAI LAViIREGt1� TING ONS RUCTION OR THE PERPORM1IANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER Of THIS PROPERTVI PER O � THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS I.AW 18.27 dC�J AND .200 WAC. <br />DEBIT & CREDIT CARDS ARE NOT ACCtPTEn <br />