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��rERMIT APPLICAI �ON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-887 0 - FAX 425-257-8857 <br />SITE t,DDRESS <br />IZI S' w�� ST <br />LOTNO. I BLOCK <br />Q�+z.1 i G8o-D <br />I PAR�EL TAl( I.D. N I�� �T� � <br />LC�ti3916"�ooz�oc !v-v;3 <br />TRACT <br />W R-�L.�ht� w� Tv'�I•1�.�L 1�31T 1�.iA-�.�. ST <br />TENANT NAME CONTACT NAME <br />E�J fc R-F T'r P�1� TD Q�t.TS I{� � t� !Z/�+�t � � 1 �T <br />CONTRACTOR <br />Pac �ic. N� s�at� <br />PNON� z S� 6ti 3- 3�`+5 <br />PROPOSED USE OF BUILDING I <br />CONTRACT PRICE OF WORK � <br />ADDRESS <br />( 3'-� Z-1 5 E Z �'r" P c. <br />`��Lt-C�/uF w✓�' <br />(� Building Mechanical <br />PEnM1T �j Combinalion ��umbing <br />TVPE ❑ Demolition Sign <br />U Sprinkler <br />EJ���rr, w►� 9b�r.o � <br />�N2S�6�i3-3� 99 <br />ZIp CONTR. UCENSE • <br />98d of <br />'+�'�A� � ��lS"x i �N <br />Add+tan <br />a�era�a� <br />Naw <br />RapsirlMant. <br />�ICQI �JVYnVG <br />[� Electric <br />D 6on « <br />CITV OF EVERETf LOCAL SALES TAX CODE IS �105 <br />WORKDESCRIPTON �NST9'f-L /.ifw i/41J�L� COwINGG1' ?'O <br />��R<<.iTS <br />NO. I TYPE OF fl%TURE OR fTEM <br />WATER CL(.SET <br />BATHTU6 <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />ORINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOPIETC.) <br />OTHER <br />NO. <br />Su �➢u�D �'aK-�'�D <br />TYPE OF Fl%TURE OR REMI <br />A/C - AIHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <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 CEFITIFY THAT I HAVE REAC �' .%Ah1INED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. AlL <br />PROVISIONS OF LAWS AND OfliDINAC � �VERNING THIS TlPE OF WORK WILL BE COMPLIED WRH WHETHER SPECIFIED HEHEIN OH <br />ST� TE OA LOCAL'LAW REGULATI G C� .o RUCTION OR THE PERFO MANCE OF CONS R CR ON.CTHAT AM AOU ISTHOH2ED BY THE ER <br />OWNER OF THIS PROPER: ( TO PERFORM THE WORK FOR WHIC.: APPLIC>TIO� IS MADE AND 1 COMPLY WITM TME STATE <br />CCNTRACTORS LAW 18.27 RCW AND 29G.200 WAC. <br />Z, oz � , M� <br />�ate j �� � <br />�� �� <br />t <br />