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r <br />PERIIIIIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, VJA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />/���D �/It �✓�' !�/ <br />LeGAL LOTNO. BLOCK <br />TRACT <br />PARCEL TAX I.D. # <br />L�LU'C'')7 �-✓C5! /ti-ve y�,vch.r.� C � c_ <br />TENANT NAME I CONTACT FOR PERMIi <br />S c^c, r /I �Crn,r /1C�7lY[ 7)[-.t-T <br />F�RI.71T � <br />ZIP PHONE <br />PHONE <br />Y. •• <br />CONTRACTOR �J�J,�,vSdv A�ORESS 21P CONTR.LICENSE# <br />/J�.uc� .- � <br />7�i�33v iJ�/r;i ,�.�z• n�c �.a..� r.Yz�zc <br />PHONE (?4^J�C/�''3 -7�/L� �,(-'��3 .� <br />A.0 � ..��.��✓.,i <br />PROPOSED USE OF BUILDING I f� Building f� Me�hanical Addition HEAT SOURCE <br />PERMIT �-� Combination f-� Plum6ing WORK Alteration Eiectdc <br />A .JJ, � � o . �-� ,2• I--( �Y Q <br />TYPE �j Demolition �, Sign TYPE � New �,j Gas <br />ilc--n.:c-»n��: it��s.^� U 5 rinkler <br />P RepairlMaint. U Other <br />CONTRACT PRICE OF WORK ¢' ��- �,�.,.L CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />WORK DESCRIPTION <br />Pt.....».e.i... o. F�a <br />//✓�...� C> <br />N0. I TYFE OF FIXTURE OR ITEM <br />�- WATER CLOSET (TOILET) <br />BATHTUB <br />Z LAVATORY (WASH BASIN) <br />z SHOWER <br />� KITCHEN SINK 8 DISPOSAL <br />_ DISHWASHER <br />LAUNCRY fRAY <br />GATHES WASHER <br />URINAL <br />DR!NKING FOUNTAIN <br />FLOOR DRAIN <br />BACKF�OW PREV6NTEi� <br />SINK (SEP.VICEIBAR/MOPIETC.) <br />OTHER <br />L�,<<.�-.��v 5..�-.c <br />/ /-/.4.� J S .,�,C <br />i1��v7Ji i-�v.�ill ✓i�i.-j Oi= Rc-7-iiZ.-7l ���. j <br />N0. I NPE OF FIXTURE OR ITEM <br />A/C - A/HANDLING UN�TS <br />FORCED AIR SYSTeMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DFYER <br />RANGEHOOD <br />WATER HEATER <br />METAI FIREPLr�CE/STOVE <br />FIREPLACEINSERT <br />GAS FIREPIACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I NEREBY i,ERITIFY THAT I HAVE READ AND E.�FlAIINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF U1W5 AND ORIDINACES GOVERNING THIS NPE OF WORK 1VILL BE CO�iPLIED 6ti9TH PuHETHER SPECIFIED HEREIN OR � <br />^JOT. THE GRANTING OF A PER�dIT DOFS NUT PRESUME TO GNE AUTHORITV TO VIOLITE OR CANCcL THE PROVISION OF FlNY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORA1ANCE OF CONSTRUCTIOP:. THAT I AM11 AUTHORIZED BY TH't I <br />O�NNER OF THIS PROPERTY TO PERFORM1f iHE 4VORK FOR 6VHICH APPLICATION IS A1ADE AND I CAh1PLY WITH THE STATE �� <br />CONTRACTORS LAVJ 1827 RCW hND 266.�00 WAC. � <br />Z �7 <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED Q�Q�.'{�C`�, I <br />