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SITE ADDRE55 <br />�03sU <br />LEGA LOT NO. <br />DESC. <br />F �� <br />• <br />P�RMIT APPLICATlG-N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />`�!'� f}-tlt �cJ <br />�LOCK <br />"i RA ;T <br />PARCEL TAX I.D, i� <br />; <br />i <br />PeRNIT # I <br />Ko yo3 -003 i, <br />....�.�� ..,...�.�.,,, ��, . �..,..� �� <br />i�!}i2119u1 `' Ce,a ie2J -r �i c <br />5. / lJ�� � <br />TENANT NAME � CONTACT FOR PERMIT PNONE . <br />�,[ II <br />CONTRACTOR / �' �°l �'�' -U w O i�.,f qD�RESS Z S 37 Q � Z 9 /f/lC ZIP CONTR. LICENSE # I <br />r�� S �'Z7_3 I <br />PHONE /Z07)//1 /'�FZ7,�CZ <br />I <br />PROPOSED US[ OF BUILDING <br />CONTRACT PRICE Of WORK <br />Buildiny Mechanical <br />PERMIT � Combination R Plumbing <br />TYPE Demolilion � Sign <br />Sprinkler <br />WORK DESCRIPTION �G` D C� N!� /t� `- /�e'"��J <br />I NO. <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />B.4CKFLOW PREVENTER <br />SINK (SERVICEBAR/MOP/ETC.) <br />OTHER_ <br />�Additio'� <br />Al�eralion <br />New <br />RepainMaint. <br />HEATSOURCE I <br />�Electrm <br />Gas <br />Olher j <br />CITY OF EVERETT LOCAL SALES TAX COOE IS °105 i <br />I <br />N0. I TYP[ OF FIXTURE OR ITEM <br />� <br />FV� —A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOCD <br />WATER HEATER <br />A4ETAL FIREPLACE/STOVE <br />FIREPLACEINSERT <br />GAS FIFEPLACE <br />GASRANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />i rEREBY CE�ITIFV THAT I HAVE READ ANU EXAMINED THIS APPLICATION AND KNOW TME SAtdE TO BE TRUE AND CORRECT. FLL <br />PPGVISIONS OF LAWS AND ORIDINACES GuVERNING THIS NPE OF WORK WILL �E CONPUED WITH WHETHER SPEGFIED HEREIN OR <br />NOT. THE GRANTING OF A PERRIIT DUES NCT PRESU�tE TO GIVE AUTHORITI' TO \90L;1TE OR CANCEL THE PROVISION OF 4NY OTNER <br />STATE CR LCCAL Gl'J REGULATING CONSTRUL'TION OR THe PERFORLIANC� OF CONSTRUCTION. THAT I AA1 AUTHORIZED 8V THE <br />OVJNER OF THIS P40PERTY TO �ERFORM THE WORK FOR \VHICH APPLICATION IS M11ADE AND I CCA7PLY 11QTH THE St4TE <br />CCNTRHC70RS,�AVJ p127 RC ND 296.200 WAC. <br />�'%��.� <br />n <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />