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SITE ADDRESS <br />LEGAL I LOT O. <br />DESC. � <br />OWNER <br />i.l)1LL� <br />TENANTNAME <br />I- �RN91T API�LICATIJN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8957 <br />BLOCK � TRACT <br />CONTRACTOR �/�ERIT W1Kii/kU�L��- <br />PHODL tJ <br />—1 Z 5 ^', <br />PROPOSED USE OF BUIL�ING <br />PARCEL TAX I.D. # <br />CONTACT FOR PERMIT <br />J�FF C9Rr�J <br />ADORE55 �(A� ��,j « <br />QE� Yv� d 1JG� � <br />Buifding <br />PERMIT � Combination <br />7YPE Demolilion <br />Sprinkler <br />CONTRACT PRICE OF WORK �� �Otf 7 �� <br />WORK DESCF2IPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />��-VATORY (WASH BASIN) <br />�HOWER <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/�AR.�MOP/ETC.) <br />OTHER <br />Plumbing <br />Sign <br />J���, ZIP <br />PERMIT » <br />'11050 �-o (U <br />�ZJ -2 ! V ' ! O �� <br />PHONE <br />�lzs'-`s53-�io)ai ; <br />zni i c- I <br />CONTR. LICENSE # I <br />yvt E2l ZYVl.rl Ci � <br />HEATSOURCE <br />Electric <br />Gas <br />Other <br />1.�7 A� . `�t �OS Z <br />Adtlition <br />WORK Aiteration <br />TYPE New <br />Repaiutdaint. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 i <br />NO. I TYPE OF FIXTURE OR ITFM <br />A!C - AIHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHESL)RYER <br />RANGEHCOD <br />WATER HEATER <br />METAL FIREPLACEiSTOVE <br />FIRF?L'.CE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXA6!INED i 1�.15 APPLICATIqN ANO KNG61' THE SAh1E TO BE TRUE AhD CORRECT. ALL <br />PROVISIONS OF IAl"JS :.ND URIDINACES GOVERNING THIS Tl'PE OF \\'ORH IVILL 9E COM1IPLIED 4VITH WHETHER SPEGFIED HEREIN OR <br />NOT. THE GRANTING OF i� PERM1SIT UOES �d0 i PRESUAtE TO GIVE AUTHORITY TC VIOL4TE OR �.:.^lCEL THE PROVISION Gr' ANY OTHER <br />STATE OR LOCdL LAW REGULATING CONSTRUCTION OR THE PERFORM11hNCE OF CONSTRUCTION. THAT t AM17 AUTHORIZED BY 7NE <br />OWNER OF 7H15 PROPERT\' TJ+� PERFORAI THc 1VORK FOR 1YHICH i�PPLICATION IS 61ADE A�vO I COM1IPLY 4VITH THE STATE <br />CONTRACTOR L W 18..7 RqV AND 296200 LVHC. <br />/ �� _./ / _ /. 1„,� <br />DEBIT & CREDI7 CARDS ARE NOT ACCEPTEU <br />