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SITE ADDRESS <br />.3� � 5 h <br />LEGAL LOT NO. <br />DESC. �� ��,�� <br />�� I rl <br />TENANTNAME � <br />PHONE <br />�'ERMI'T APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />1I �-/Z-03 <br />PARCEL TAX I.D. # <br />�K �ga3o �vdc� <br />TRACT -i� u <br />�'Jc rc..�I ✓11J r`� Ic.1 �� � �- <br />�n � V V �� O� � r,] 1 Ji- <br />ICOINTACT FOR PERMITj <br />l h r� S f l o l' l a-`-1 <br />��0�'�`6 ���-- <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK '-+l <br />WORK DESCRIPTION <br />I �S l�• <br />�.K <br />h-C, 5 � <br />ADDRESS _ , <br />'�_ 13oi�( ��5� <br />,�� �.�- <br />PERMIT # <br />C �/o -C.�S <br />�iJ 1�7-b0 <br />ur rnvrc F��-�,85� <br />�.�.-�U 9��S3or7 <br />PHONE <br />C � 3g -a�.38 _ <br />ZIP CONTR. LICENSE # <br />�g�aS <br />Building ❑ Mechanical A�idition HEAT SOURCE <br />PERMIT B Combination u Plumbing WORK � PJleration � Electric <br />1YPE Demolition U Sign 1YPE New Gas <br />B Sprinkler Repair/Maint Other <br />,�� — �� � �. ��G� _� CITY OF EVERE7T LOCAL SALES TAX CODE IS 3105 <br />��l - u,Ny � �,...��.�5 <br />o Y^ • Scb' S�� i.� � S�_ <br />� � n �� � •--=� � ' <br />NO. � TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) � <br />� BATHTUB ` <br />LAVATORY (WASH BASIN) i i <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOPfETC.) <br />OTHER <br />N0. <br />/ZOG S�' .u��� � <br />//OU .s-(' �o� - �� <br />TYPE OP FIXTURE OR ITEM <br />A/C -AIHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER, <br />RANGEHOOD , <br />WATER HEATER <br />METAL FIRFPLACE/STOVE <br />FIREPLACEINSERT <br />GAS F�REPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN //// <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVlSIONS OP I.AWS AND ORIDINACES GOVERNING THIS TYPE OF WORI< WILL BE COMP! IED WITH WHETFIER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE AUTHORIIY TO VIOLATc OR CANCEL THE PROVISION OF ANY OTHER <br />STATC- OR LOCAL LAW REGULATING CONSTF2UCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OINNER OF THIS PROPERTY TO PERFORM THE WORK FOR \NHICN APFLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.°7 RCW AND 296?00 WAC. <br />., �—_— -- --- `j / 5 � � . <br />S�nalu of nedConlractor/Aulhonzed Agent ale � I <br />�. DEBIT & CREDIT CARDS ARE NOT ACCEPTED � v <br />