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SITE ADDRESS <br />� <br />LEGA LOT N0. <br />DESC. � � <br />P�RMIT APPLICATIG� �� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />_ j ;�Gl� 3c � O/(c <br />PARCEL TAX I.D. N PERMi7 x <br />a� fjRIVF EvE2Ei( �oy�� � bOO �oo �0a �p p <br />BLOCK TRACT � <br />oo:� D-o� SJ' l��>� - 3�- �� <br />S�tirunN c,u�Y �vn, s c��i5 �o�" Avr sE ��EaE�7 <br />(�NftNEF G.P� .6n1 <br />TENANT NAME CONTACT FOR PERMIT <br />Si�i Mn N�+Y7o� R- PH�NF F �t.nY7u <br />SI��PHAN 'C.t.AYTUN <br />CONTRACTOR c � ADDRESS <br />PHONE � 1��� �d'N ��� � /;i il..`� L._ <br />PROPOSED USE OF BUILDING <br />S f F� <br />CONTRACT PRICE OF WORK <br />WORK DESCHIPTION <br />NGw uvvsE <br />NO. I TYPE OF FU(TURE OR REM <br />WATER C _OSET � ! / <br />BATHTUB J/ <br />LAVATORY (WASH BASIN) �-i/� <br />SHOWER I� <br />KITCHEN S��'K d DISPOSAL <br />OISHWASHf_P. <br />LAUNDRY TRAY <br />CLOTHESINASHER <br />UR�NAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/8AR/MOP/ETC.) <br />uTHER <br />Buiiding Mechenical <br />PeRM17 Combination R Plumbing <br />TVPe ;' �molition D Sign <br />Sprinkler <br />�� <br />wA qsau� (y-� s )�µs -va�9 <br />PHONE <br />C({-aS��7(FS-Oa49 <br />ZIP CONTR. 110ENSE A <br />�Adtlition I HEATSOURCE <br />Altaration � Electric <br />New Gas <br />Repair/Maint. Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />� <br />�j�11 s � <br />NO. I TYPE OF FlXTURE OR REM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEATPUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACEISTOVE <br />FIREPLACE INSERT <br />GAS FIRFPLACE � <br />GAS RANGE <br />GAS PIP�NG <br />EXHAUST FAN f// / <br />OTHER <br />I HEREBY CEP; � IFY THAT 1 HAVE READ AND EaAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISICNS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br />NOT. THE GFANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOL4TE OR CANCEL THE PROVISION OF ANY OTFIER <br />STATE OR LOC:.� L1W REGUL4TING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY TFIE <br />OWNER OF THIS PflOPERN TO PERFORM THE WORK FOR �YHICH APPLICATION IS MAOE ANO I COMPLY WITH THE STATE <br />CONTRACTORS L1'N 1827 RCW AND 296.200 WAC. <br />' <br />_--�:i;.'(i:� � C-�� ��c+? i� ��/�� C� <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />