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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVIC.ES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />9da� �� w <br />.:� LOT NO. BLOCK <br />. <br />=_5�� 3 <br />OWNER <br />Sc�T 7'ohrr5•�� ll�� <br />TENANTNAME <br />CONTRACTOR � <br />Tphr"rSJn �}l1w) 4 f(�/}:tj <br />PHON <br />�4lsi $D9 yl� � o <br />PROPOSEO USE OF BUILDING <br />S � � PERMIT <br />TYPE <br />�• O <br />CONTRACT PRICE OF WORK I' � <br />WORK DESCRIPTION <br />� b�;�d ►�ew <br />j . � . (Z. <br />NO. � TYPE OF FIXTURE OR REM <br />PARCEL TA% I.D. # <br />�070o1o15ar�S <br />TRACT <br />fl. <br />I l .'��t .T�E /I.�; <br />CONTACT FOR PERMIT <br />ADDRESS <br />•�/� /UV � St S� <br />s�..te G-� <br />Bwlding Mochanical <br />Combination R Plumbm9 <br />Ucmollfion p Sign <br />Spnnkler <br />� �� �0�� <br />P�G� i�'�, v <br />3 '.VATER CLUSEI (TOILEn <br />.2 BATHTU9 <br />�' LAVATGRY (WASH BASIN) ,. <br />� SHOL'/ER <br />! KITCHEN SINK 8 DISPOSAL <br />T OIShfiYASHER <br />LAUNDRYTRAY <br />� CLOTHESVJASHER <br />URINAL <br />DRINKING F�UPlTA1N <br />� FLOOR DRAI.J <br />BACKFLO'N F'REVENTER <br />SINK �SEPVICE/BARlMOP/ETC.) <br />_I OTHER _ <br />=I — <br />—i <br />l��311-� <br />IT q <br />� �/- o <br />PHONE <br />21P CONTR. LICENSE / <br />.7�h�,.S/,pG83 G �- <br />aca�uon <br />WORK Al�era�on <br />TYPE New <br />L. Repa�nMamt <br />MEATSOURCE <br />�Elactnc <br />Gas <br />Othar <br />CITY OF EVERETT LOCAL SALES TA% CODE IS ]705 <br />le�lo U �/6 � <br />��-s3 !L �aL�� <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — AlHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMF <br />UNIT HEA � ERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE�STOVE <br />FIR[PLACE INSERT <br />GA5 FIRF.PLACE <br />GAS RANGE <br />GAS PIPIMG <br />EXHAUSTFAN . <br />OTHER���st iu., <br />��E?EBY CERITIFv'HF7 i HAVE REFD AIJD ERAIAI4ED THIS APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />;%��':`AS�ONS OF tp.WS FPiD ORIDINACES GOVERNIDIG i HIS TYAE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED IIEREIN OR <br />'•0' 'ME GRFNTING OF F PER1.!IT DOES q07 PRESUtdE TO ,I'✓[ AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY .iTHEH <br />'aJE OR LOCFL LAY� REGUTATR�G CONSTRUCTION OR THE PEHFORM4NCE OF CONS7RUCTION. THAT I AM AUTHORIZED �V THE <br />,�:'.ER OF TMiS P(70PERN 7p PERFORIA THE WORK FOR WHICH APPLICFTION IS IAADE AN(1 I COMPLY WITH THE SThTE <br />,CV71?FCTOFS WW i827 RCAl.t:D 296.209 WAC. <br />� /- as-v3 <br />`/z <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />