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SITE ADDRESS <br />NO. <br />TENANTNAME <br />( � <br />PtRMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />s�3 TRACT <br />PARCEL TAX I.D. if <br />03�'3�1 � � <br />3y�`f y� 0�. U. <br />� CONTACTFORPERMIT <br />(G307 -�3-5 <br />PHONE y�- <br />_�s"- Z3 <br />PHONE <br />T�S C�ns-1-�v�-rz�vJ � C�rnv C�oosrng�--� �'I�=3�°I�7�{go <br />CONTRACTOR ADDRESS 21P CONTR. LICENSE R <br />� Ce o3 �'y� /-�1L� �Ve�- �jtsZD3 -��Seo � 0145� N� <br />PHONE <br />PROPOSEO USE OF BUILDING <br />S�N(�.�. FArt��Y <br />� s � b14�v� � <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />���� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Building Mechanical Adaition <br />PERMIT � Combination � Plumbing WORK � Alteration <br />TYPE Demolitian Sign TYPE New <br />Spnnkler RepalnMaint. <br />HEATSOURCE <br />Elechic <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WATEP. CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACI<FLOIN PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER_._ <br />NO. I TVPE OF FIXTURE OR ITER1 <br />A/C—A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HE�TERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPIACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />I IIEREBY CERITIFY THAT I HAVE READ AND EW+MINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS. TYPE OF WORK WILL BF COA9PLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION CR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2E0 BV THE <br />OINNER OF THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CO ACTORS LAW 18.27 RC AND 2 200 WAC. <br />�', ., _ �� � ,.� . � �- - Zl - n'7 <br />%z <br />CREDIT CARDS ARE NOT ACCEPTED <br />