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PE�.�MIT .APPLICATIa,d <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br />l ���� �, � ; ; �� � 1 <br />SITE ADDRESS `: ' � � PARCEL TAX I.D. M <br />�,,�I ����,.f���c l�.`(���. <br />LEGAL LOT NO. BLOC <br />DESC. <br />i <br />OWNER <br />�'"1'(1"�„ `, ��'�rlv�;�; C`. j'�L�2(' <br />1 ��r <br />TENANT NAME <br />ADDRESS � <br />�� 7��' \�1..��-=�, <br />r �, r' •. ; �-i _' <br />I CONTACTNAME <br />� � �� � �`l,ll �j (� <br />� <br />i: --�"i��l.l.� <br />�.. C�1 �� Rl I� IR \i 1 iti�C� U � I 1�,�C' I_ ADDRESS -- <br />� � i 1 � � ��� ��� � � ��� <br />PHONE -�1��:��=Li�'�(��� � I i��� I,II�'� ��.���) � <br />PROPOSED'!�E OF BUILDING <br />���1.��� �ilil�i��� <br />4;� �',AL� t �L,�_ <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />l i � �,�� �k�� t 1 <br />PERMIT # <br />:,� f.�_�. <br />_, <br />� PHONE <br />iPHONE <br />� <br />I CONTR. LICENS[ B <br />� {�'�' �-'� jl,l,l��Vl�` 1�� l"I�>Zll�vi�l <br />Building D Mechanical AdCINon HEAT SOURCE <br />PERMIT B Combina6on �J Plum6in� WORK B Alteration D Electnc <br />TYPE � Demolition U Sign TYPE �� New U Gas <br />.�� Sprinkler U Repaidhlaint. U Other <br />CITY OF EVEREiT IOCAL SALES TAX CODE IS 3105 <br />��;i), �� i� �� 6<' <br />NO. I TYPE OF I�IXTUflE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATOFY (WASH BASIN) <br />SHObVER <br />KITCHEN SINK 8 DISFOSAL <br />DISHWASHER <br />IAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOJNTAIN <br />FLOOR DRAIN <br />BACKFLOW PRE:ENiER <br />SINK (SERVICE/BAR/MOP/ C.) <br />OTHER�'f �L( Y' ��C.�_ I �� <br />E <br />� ` j � <br />���-��� <br />NO. � TYPE OF FUCTURE OR ITEM17 <br />A/C — AlHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEATPUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />_ GAS AANGE <br />_ GAS PIPING <br />EXHAUSTFAN <br />_ OTHER <br />. <br />I I HEREBY CERITIFY THAT I HAVE READ AND EXAM1IINED THIS APPLICATION AND KN06Y THE SAh1E TO BE TRUE AND CORRECT. AlL <br />I FROVISIONS OF IA�VS AND ORIDINACES GOVERNING THIS TYPE OF WOFK WILL BE COh1PLIED VlITH WHEfHER SPECIFIED HEFEIN OR <br />� NOT. THE GRANTING OF A PERP.IIT DOES NOT PRESUM1IE TO vIVE AUTHOFI7Y TO VIOWTE OR CANCEL THE PROVISION OF ANY OTHER <br />� STATE OR LOCAL LAW I;EGUWTWG CONSTRUC710N OR THE PERFORM1IANCE OF CONSTFUCTIOR. THAT I AM AUTHORI2ED BY THE <br />04JNER GF i HIS PROPERTY TO PERPORM THE WORK FOR WHICH APPLICATION IS tdADE A�D I COM11PLY YlITH THE STATE <br />CON.If;ACTOFS L1W 18.2 RCW AND 29620G WAC. <br />�, i�� �� �_ ��,�i i 1%� C �� ��. �,��_, Irl �� <br />