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� <br />CRMIT APPLICATIUN <br />GITY OF EVERETT PE►`MIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />� � 425-257-8810 — FAX 425-257-8857 <br />• � �` � ` �"� � � �> �' <br />SITE ADDRESS <br />c27 - �i �' Sr <br />LEGAL LOT NO. <br />� C <br />PARCEL TAX I.D. # <br />E. E�a�F�r 9�vrl �6z�'-os�-oo�- o0 <br />BLOCK I TRACT <br />� <br />TENANTNAME CqNTACTFORpERM1T PHONE <br />K�rTH Aws�="`: �'� 4'ZS-s/3-89�9 <br />'Z��lv9�j :� 7�0 <br />CONTRACTOR�AGIF�� ��S ��5?. ADDRE55 ZIP CONTR. LICENSE# <br />l3b19 Mo�t��Teo s�Eo�; pqu �-�c �o� a� <br />PHONE ��TG D6 PM'6 1150 <br />4'zs-5�3-sr�9 c.vNNwooD.�.�a 98037 <br />PROPOSED USE OF BUILDING <br />PERMIT R <br />NPE D <br />U <br />Building Mechanical <br />Combination R Plumbing <br />Demolition D Sic�n <br />Sprinkler <br />Addition HEAT SOURCE <br />WORK Alteration Q Electric <br />TYPE New u Gas <br />RepaidMaint. U Other <br />CONTRACT PRICE OF WORK �� J,!� � l� -� CITY OF EVEREIT LOCAL SALES TA% CODE IS 3105 <br />/ <br />WORK DESCRIPTION <br />Lo��2�c7icu �F A N�w MAi+�rE.�—WNC< ���or�UG <br />fl'T -TNE GITY oF �.�.L.'CiT WATri2 �o���.��J CoN'R2.�� FHc1��T`�. <br />NO. I 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 />BACKFLOW PRFVENTER <br />SINK (SERVICEiBAR/MOP/ETC.) <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C—A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAM1IWED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAVJS AND ORIDINACES GOVERNING THIS TYPE OF WORK N'ILL BE COMPUEU N9TH WHETHER SPECIFIED HEREIN OR <br />STO TE OR IOCALJ.A .�REGUERMIT�D�oN N HECNORK FOR WHICH AOPPM CA OONFS M DE ANOD !OCOMPLY WITH TOHE 30RIZEED BY � EHER <br />SI <br />ON'NEF OF THIS� PERTY O ERFOR��(JY <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />