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f <br />NERMIT APPLICATIVN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />F�i' C <br />BLOCK <br />PARCEL TAX I.D. # <br />Q 4 c� y'"1 � f�C9 c� c� c5 <br />TRACT�I�/ /L7t �.� �/< � S <br />o-Da <br />I�EViN Tu 2�1�=2 S.�'31 -�tis� C��,e 5'�w3 y2s3Y8 z� <br />TENANiNAME CONTACTFORP MIT pHONE <br />C'u- ����e�.e 4,.., yz.f �y � �73 0 <br />CONTRACTOR <br />C_EN 7 �/C / /�[ C <br />PHONE _I)��C% SE�� �G[� <br />X. <br />PROPOSED USE OF BUILOING <br />2E� <br />CONTRACT PRICE OF WORK <br />��£- ADDRESS /lO p�� /�� <br />r r� < <br />5',clD/�vAtcs !.� <br />I Bui'd(ng <br />PERMIT R Combination <br />TYPE g Demolition <br />Sprinkler <br />,.i �f !'—�'�-" <br />Mechanical <br />P�umbing <br />Sign <br />21P CONTR.LICENSEif <br />��'r � KFcrZ�'z <br />�Addition <br />AlleraUon <br />New <br />Repair/Maint. <br />HEATSOURCE <br />lectric <br />Gas <br />Other <br />CITV OF EVERETT LOCAL SALES TAX CODE IS J105 <br />WORK DESCRIPTION <br />C flA�tl � F c��� �� 2�/�� �� cv�--r�'-�L <br />��� � �-�►� <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUN�RYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />��r-z��i2 <br />NO.. I TYPE OF FIXTURE Oli i TEM <br />A/C—AIH: h�JLING UNITS <br />FORCED Ai�t SYSTEMS <br />HEAT P�MP <br />UNIT HEATERS <br />CLOTHES DF2YER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RAP GE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND I(NOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT �OES NOT PRESUM1IE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LUCAL LAW REGULATING CONSTRUCTION OR TFiE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27'RitW AND 296.200 WAC. <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />