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F�RMIT APPLICATI�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDHESS <br />832 I�UU��fz- f�v5 <br />LEGA LOT W0. BLOCK <br />oesc. I$� I� , 20 I i D <br />PARCEL TAX I.D. # PER IT n <br />aos�3zr�oalsoo �3U�� <br />TRACT <br />t�DY �� � ca ��oN � s��e�T�orJ <br />JoFL �{ I�ATNY (-��5�1�1 I"Izzs �Ttt P;v'c w <br />TENANTNAME CONTACTNAME <br />I<<M ���DrLm <br />CONTRACTOR ' ADDRESS <br />�PIIJLT2-NllL�EK ING• S2zJDH��I �T �t <br />PHONE Gj�i��L�i ��OI D- I <br />'l/I/n 24� � �?. �l �' <br />PROPOSED USE OF BUILUING <br />�Ir�IG-q,E F.rnn��`� <br />�-��✓I DENCC <br />CONTRACT PRICE OF WORK <br />[� uilding D Mechanical <br />PERMIT 1�3 Gombination f) Plumbing <br />TYPE D Demolilion � Sign <br />�> Sprinkler <br />�e�EI.L ��017 �25 <br />PHONE <br />2D(c ¢�3 52ZZ <br />ZIP COtJTR. LICENSE M <br />�'ii�f1/UVl I 1'I 4 N G <br />Adaition <br />WORK Alteration <br />NPE �ew <br />RepniriMaint. <br />HEATSOURCE <br />Eleclric <br />Gas <br />Other <br />qTY OF EVEREIT LCGAL SALES TA% CODE IS 3105 <br />WORK �ESCRIPTION <br />1�Etit0�ITlor�! oF �XI��'1. {1D21TlON, PLAY�-YDUSE � C�KitG-E •%l�l/ A'ii�AG!'���� <br />2 G�k12 �i�}�1�� /�t�W DET"AGf-I Lb �-GAIL- C�/tiz�G--E . J�DCzM�� kti7fi�lilDfJS <br />� jYLT6t'ATIDN `t7� �XI�1T 2E�i1 ��rlG� . <br />NO. � TYPE OF FIXTURE OR ITEM <br />WATEF CLOSLT % <br />BATHTUB <br />LAVATORY (WASH DASIN) ,�;, <br />SHOWER 7 <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC J <br />OTHER <br />NO. I TYPF.:�F fl%TURE OR REM <br />A�C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS - R�Y�L1kG1 NLl <br />HI=AT PUMP <br />U�IIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACEINSERT <br />GAS FIREPLACE - I ���E�LT <br />GAS RANGE <br />GAS PIPING <br />EXHAUSI FAN 1// <br />OTHER _ <br />I HERE9Y CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME 1G BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK W!LL BE COMPLIED WITN V:HETHER SPECIFIED HEREIN OR <br />NOT. THE GPPNTING OF A PERh11T DCES NOT PRESUhiE 1"O GIVE AUTHORITY TO VIOL4TE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL lAW REGUWTING C:ONSTRUCTION OR THE PERFORh7ANCE OF CONSTR��CTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERN TO PERFORM ThIE �VORK FOR IVHICH APPLICATICN IS A7AD� AND I CONPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 290200 WAC. <br />G'u1 �r�YG�� <br />��, <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />��2 <br />