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SITE ADDRESS <br />� J'� J/ <br />LEGA LOT NO. <br />DESC. <br />CONTRACTOR ,� r <br />LG�i t/.'Y 91�d / �'�'" <br />PHONE <br />PROPOSED USE OF BUILDING <br />�NERMIT APPLICAI�ION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />// PARCEL TAX I.D. # <br />� i� G��U/ !1 <br />BLOCK TRACT <br />ADDRESS <br />�//% S/S/ Oh S�j/ <br />� CONTACT FOR PERMIT <br />//�l '%/r' �.4'rt <br />PERMIT <br />TYPE <br />PRICE OF WORK <br />WORK DESCRIPTION <br />(' t'i-1���U ,I ��f� �r <br />PLUMB <br />NO. � TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DR,41N <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />ADDRESS <br />s �. r✓o� {� q,r�-���" <br />�Building Mechanlcal <br />Combination R Plumbing W <br />Demolilion � Sign T <br />Sprinkler <br />PERMIT # <br />.30� <br />ZIP PNONE <br />� a��3 1-i 7 y'; <br />PHONE <br />ZIP CONTR. LICENSE A <br />�ehsAd�c�ybG (� <br />Additlon <br />aterauon <br />New <br />RepaidMaint. <br />HEATSOURCE <br />F.lectric <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />NO.. � TYPE OF FI%TURE OR ITEM <br />A/G — A/HAN�LING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL !'IREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING O.'- A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OP ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BV THE <br />OWNER UF THIS PROPER TO :� RFORM THE WOkK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONj CTORS W 8. RCW F(�JD 6.200 WAC. <br />. :��.�%/� �� ��� :�- ��- -�� � <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />