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SITE AD�RESS <br />� /-;' <br />LEGA LOT A'O. <br />OESC. <br />OWNER <br />� ,� .; i-: <br />TENANT NANE <br />CONTRACTOR <br />PHONE <br />PERMIT APPLICATI�N <br />CITY OF EV;�RETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />, ,_, , �' �'r, /l vr <br />BLOCK <br />�^ � r /;, <br />7_ r_�d <br />PROPOSED USE OF BUILDING <br />�i i , �( .� <br />CONTRACT PRICE OF WORK <br />PARCEL TAX I.D. # <br />A- 3 �i i ( I n C7 (. C7 O <br />TRACT <br />%. C �% l� OL K C i I[ i C; <br />CONTACT FOR PERMIT <br />„%;�. � l!%.. <br />ADDRESS <br />6uilding D Mechanical <br />PERMIT � Combination �J Plumbing <br />TYPE Demolitian �] Sign <br />Sprinkler <br />TYPE <br />3EZo� <br />21P <br />PERMIT It <br />��/D-b� <br />?l�-75,. F�-, <br />PHONE <br />�15-Z:' � ,-. <br />CONTR. LICENSE K <br />Addition <br />/UteraUon <br />New <br />RepaidMaint. <br />HEATSOURCE <br />[� EbcMc <br />B Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAIf CODE IS 7105 <br />WORKDESCRIPTION �/�-��1 A(1� C901�r! -�/ -'�i" =. r?cIICAIt_ OLD Do0R5. SI�IM rC�:�' <br />(li �_ L ��: =,r�:i . .� �fJl� i��i� .. .. ! r✓'�%. ji—,�1�i f+T r �Vr•,i(. /2Gc:...� p����n.�v�: <br />.. . � . , ... ,- i /.-., <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />IAVATORY (WASH BASIN) <br />SHOWER � <br />KITCHEN SINK 8 DISP�SAL <br />DI.iHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PRcVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />� <br />NO. .I TYPE OF FIXTURE OR ITEM <br />2YlJALL OVY;� ' <br />�DC jjj5t f�C�RDS � <br />A/C - A/l�ANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNITHEATERS — Fr t �^�. �� <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />tJAG� <br />I HEREBY CERITIFY THAT I riAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AN^ ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT RRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTNORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />COI�RACTORS LAW 18.27 RCW�ND 296.200 WAC. <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />