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SITE ADDRESS <br />37rv � �,, <br />LGGAL LOT NO. <br />DESC <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 96201 <br />425-257-8810 - FAX 425-257-8857 <br />r �e =Vfff 11 <br />BLOCK TRACT <br />PARCEL TAX �.D. # <br />/�.-05 05 <br />PERMIT �t <br />kvs�� oa� <br />.�UrPhy 1�4i�.�rR�_�a�r 3o09w..,�lwrrn� (�r, fv�K-M� �`il <br />TENANTNAME CONTACTFORPERMIT PHONE <br />C�-t n � Vo(os%�an%to (4LS� R81 `O1Q'� <br />CONTRACTOR E'�'�«'� S eD Y< f�.qODRESS %(D7- I��/�,.c NE ZIP CONTR.LICENSEI <br />(�c,(,u�n� H!� 9t�r't WEsTESFf3LQf <br />PHONE �' j 2� � Y$ �"�/ CO <br />PROPOSED USF. OF BUILDING <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />Building Mechanical <br />PERMIi Combination � Plumbing <br />TYPE Dentolition Sign <br />nn r� <br />rifC J�il�l%C�Pr SI,STt.� <br />N0. � TYPE OF F�%TURE OR ITEM <br />WATER CLOS[T <br />f3ATIiTUD <br />Ll�VATORY (W�SH BASIN) <br />SFiOWLR <br />KITCHEN SINK 8 DISPOSAL <br />DI5IIWASHER <br />L�UNDRY TRAI' <br />CLO7HE5 WASHER <br />URINAL <br />DRINKING I'OUNTAIN <br />FLOOR �RI11N <br />BACKFLOW PREV[NTEF. <br />SINK (SERVICE/BAR/MOPIETC.) <br />OTHER <br />Additian HEAT $OURCE <br />WORK Nler tion Eledric <br />TYPE New � Gas <br />Repai�/Mainl. Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />T� �-h�l�afio� <br />NO. � TVPE OF FI%TURE OR ITEM <br />A/C -AIHANDLING UNITS <br />FORCED AIR SYSTEMS <br />I1EAT PUMP <br />UNIT IiEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WnTER HEATER <br />M[TAL fIREPLACE/STOVE <br />FlRFPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PINING <br />EXHAUSTFAN <br />OTHER <br />I HEREDV CERITIFY THAT I HAVE READAPID EXA�1M[D THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND WRRECT. ALL <br />PROVISIONS OF LAWS AND ORIDMACES GOVER�ING THIS TYPE OF V�RK IMLL BE COMPLIED WiTH WNETHER SP[GRED HEREIN OR <br />NOT. iHB GRAIJTING OF A PEHMIi �OES NOT PRESUId[ TO GIVE AUTHORITY 70 VIOUITE OR CANCEL THE PROVISION Of ANY OTHER <br />S7ATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORIdANCE OF CONSTRUCTION. THAT I Ald AUTHORIZED DY THE <br />OINNER OF 1HIS PROPERTV TO PERFORM1I iNF WJRK FOR Vv111CH APPLICA710N IS MADE AND I COh9PLY IMTH THE STATE <br />CONTRACTOR 5 LAW 1 B.27 RC W A�D 29G 200 WAC. <br />/ <br />--- � Cc.,- /2��/v i' <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />