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PCRMIT APPLICATIUN <br />CITY OF EVERETT I�ERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS Z��n� Ui R(�r,y�,� Ru� DDy 37 �3 ��9c�Z3 E� <br />LEGAL LOT NO. BLOCK TRACT <br />DESG 23 ! ?_� � (o� � CI<� R��i( / /� f ✓ / <br />�1'1Hrt� ?ow.nSon � �v� <br />TENANTNAME <br />� �r .� <br />CONTRACTOR P�L`�_„ (Yq�qv.LS <br />PHONE 11 Z� .Z;q f,) 1� <br />PROPOSED USE O^F BUILDING <br />Q a%. �-h1 c.`✓ <br />Gqrnrfr¢ <br />CONTRACT PRICE OF N'ORK <br />Z'� 1 cg (%I R C� r,/� IA .,¢Jt f�7.J� <br />CONTACT FOR PERMIT <br />�Rv+� A�6.aR�mba <br />AD9RESS z72(o RJC..�ICJ; (a�2 <br />Building Mechanical <br />PERMIT Combination � Plumbing <br />7YPE Demolilian Sign <br />Sprinkler <br />�; �7 - oiv <br />�RMIT # <br />> 30 7� D([ <br />IJ:[.1:I� <br />ZIP CONTR. LICENSE p <br />95�� <br />?Au clr�.oa4 rN <br />Adtlition NEAT SOURCE <br />Alteration `' EIe�Nric <br />New ��{ Gas <br />Repair/MainL . Other <br />CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORKDESCRIPTION ��/7��j .� �±� /.� �Il� <br />I) a.Z � �c-� ��rr�-G,S, �( � c� l�1 <br />NO. I iYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVAT7RY (WASH BASIN) <br />SHOVv'eR n <br />KITCHEN SIN}{ B��I ,- SAL <br />DISHWASHEf�I � - <br />LAUNDRY TRA�Y <br />CLOTHES WASHER <br />URINAL <br />�RINKING FOUNTAIN <br />FLOOR DRAIN <br />EACKFLOW PREVENTER <br />SINK !SERVICc/8AR/MOP�ETC.) <br />OThER <br />NO. I TYPE OF FIXTURE OR I7EM <br />� <br />A/C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEATPUMP <br />UNIT HE.>T[RS <br />CLOTHES DR'r �R n <br />RANGE HOOD � � <br />WATER HEATER <br />METAL FIR: ,`! ^CE/S VE <br />FiREPLACE IN:�cRT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPIICAT10N AND KNOW THE SAME TC BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIJINACES GOVERNING THIS.NPE OF WORK WILL BE COMPLIED WITIi WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OFl�NY OTHER <br />STATE OR LOCAL LAW REGUWTING CONSTRUCTION f^ THE PERFORM1IANCE OF CCNSTRUCTION. THAT I AM AUTHORIZED B'! THE <br />GVJNER OF THIS PROPER7Y TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS uiW 18.27 RCW AND 296200 WAC. <br />� � .�_�_� 7.2'{_03 � <br />Signature of OwnedContraclodAulhonz nt Date i <br />IZ <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />