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SITE AD�RESS <br />� � � �Z <br />LEGAL LOT NO. <br />LVtRt� <br />TENANTNAME <br />PERMiT APPLICATIOM <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />BLOCK I TRACT <br />CONTRACTOR <br />yVl H2 L i )1� L-Ct4i1A7 t CH [., 1L'L <br />PHONE _ <br />PROPOSED USE OF BUILDING <br />PERtdIT <br />TYPE <br />CONTRA(:T PRICE Of WORK <br />PARCEL TAX I.D. # <br />CONTACTFOR <br />��Ff <br />PERtv11T = <br />� rOC� 0�'U l� '�'�I D <br />P I�L�� l <br />ZIP PHONE <br />(G1- 75SZC� `l2S-ZSZ- los%; <br />PHONG <br />Lk ! • <br />u7�;-�SC�'�1�,��� 12y <br />AD�RESS <br />!S�1 Ui24�utq- <br />�U�I2i'ii, I�,1�.�1 <br />RBui!ding <br />Combinatic <br />BDemolition <br />Sprinkler <br />ZIP <br />t1UC-. <br />CONTR. LICENSE # <br />yf��21. i N-tCl�',�/ <br />�dech2nical Addition <br />(�IumbiOg WORK Alleration <br />Sign TYPE 'ew <br />Repair/t.laint. <br />HEATSOUZCE <br />Electric <br />as <br />Other <br />CIN OF EVERE �iT LOI:AL SALES TAX CODE IS 3705 <br />WORK OESCRIPTION <br />CC�i1S �O �d1S ��J�iiE2 ItF�I7L-�L J1f���9Cl�C-� <br />NO. I NPE OF FIXTURE OR ITEId <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVA704Y (WASH B�SIN) <br />SHOWC-R <br />KITCHEN SINK & OISPOSAL <br />DISHWASF'ER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SEZVICE/BAR/MOP/ETC.) <br />OTHER <br />� <br />NO. I TYPE OF FIXTURE OR ITEM <br />PJC — A/H.4N�LING UNITS <br />FORCGD AIR SYSTEMS <br />HEAT PUI�1P <br />UNIT HEATERS <br />CLOTHES DRYER <br />RAt:GE HOOD <br />� WATER HEATER <br />tv1ETAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />ui+5 f'v�IJGE <br />GAS PIFWG <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERITIFY THAT I HF�\'E READ AND EXAGllNED THIS APPLICATICN AND KNOW THE SAh1E TO BE TRUE AIJD CORRECT. ALL <br />FRQVISIONS OF LAN'S AND ORIDINACtS GOVcRNING THIS NPE OF 1h'ORK 1h'ILL BE COMPLIED \VITH \VHETHER SPECIFIED NEREIN OR <br />N07. THE GRANTING OF A PERA11 i 7JE NOT PRESU�IE TO GIVE AUTHGRITY TO VIOL4TE OR ChNCEL THE PROVISION OF FNY OTHER <br />STATE OR LOCAL LAW ftEGUL4iI���fRUCTION OR?HE PERFI�R�dANCE JF CONSTRUCTION. THAT I A�1 AUTHORI2ED BY THE <br />OWNER OF TNIS PROPERTV1 TO FERF THE VdORI: FOR WHICH APPLICAT101J IS AtADE AND I COIAPLY WITH THE STATE <br />!`.nNTRACT(1R5 LAW SA.27AtC1N A � CO \VAC. , � <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />