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SITE ADDRESS � , . <br />' �,�• I' „"('E F/; <br />LEGAL LOT NO. <br />DESC. j ../ ( � r, <br />� <br />� -`�'17���-- <br />TENANTNAME <br />. <br />'' -/�t' �i. <br />CONTRACTOR <br />� � <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />�('r' �� <br />BLOCK <br />�; l(� i'�� � <br />i d <br />PHDNE j ;(,( 1 I� � �i <br />PROPOSED USE OF BUILDING <br />I?� r <br />�'' � � . <br />i " � <br />CONTRACT PRICE OF WORK j�� <br />PARCEL TAX I.D. # <br />': � f--9�-2_ �» -c�.� <br />TRACT <br />� / / <br />ii 2 A^cf F.! �// <br />CONTACT FOR PERMIT <br />( �l,i�J�' i' h: <br />ADDRESS <br />f y �� e Fr�a.� � <br />Building Mechanical <br />PERMiT Combinalion R Plumbing <br />7YPE Demalition p Sign <br />Sprinkler <br />'��'j C`��G%' <br />PERMIT # <br />rnuryC �: <br />���0� � <br />PHONE <br />ZIP CONTR. LICENSE # <br />Addition HEAT SOURCE <br />Alteratior, � Electnc <br />New Gas <br />RepairlMainl. Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 1105 <br />WORK DESCRIPTION <br />�'�rt"�(t�r'l/�,�/y'!i/�1 � �J� .� i"t:� ,�u ��1�� �'�[�f�/7 <br />i ll""!; .;,.i�r �;, �^iif , F�C �i�"Irl ,�7 1�,fJ�C."'';�11 s.� <br />� , <br />NO. � TYPE OF FIXTURE OR ITEA7 <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 />UR�N,�L <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />i <br />F>:��-�.i���' � <br />l L%✓rY�C'� �i�� <br />NO.. � TYPE OF FIXTURE OR ITEM <br />H/l:—AIHANULING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />M=TAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />�r�f � <br />I H[REBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNO'N THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. TFiE GRANTING OF A PERh11T DU�� NOT PRESUME 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 AA� AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFOR�4 THE WORK FOR WHICH APPLIi;AT�ON IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACjORS LAW 18.27 RCW i,ND 296.200 WAC. <br />, �9,-' ' '� .'�' = �•_ ����3� 7 ��2 <br />SignaWre of OwneNContracrodAuthonzed Agent Dai <br />DEBIT 8 CREDIT CARDS F,RE NOT ACCEPTED <br />