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PERMIT APPLICAYION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRESS <br />� z s� �r S� S� st s w <br />LEGA LOTNO. BLOCK <br />DESC. <br />OWNER <br />�p;+/�-n,i� 1��-cv�ve�wsk-c <br />TENANTNAME <br />CONTRACTOR �,���,,,� <br />ivS7�,L llR� w A'�+- �/"' �= � us+��rtA t <br />PHONE <br />2 �Sb 47a� 44R'i %ktS 2SY �f'6 <br />PROPOSED USE OF BUILDING <br />PARCEL TAX I.D. # <br />TRACT <br />ADDRESS <br />2:514 5ls` St Sw <br />CONTACT FOR PERMIT <br />Evw�r,.o ��.v�-t,��.wwsk•� <br />AADRESS <br />�tiolp �'g f�JlM ��K <br />Building <br />PERMIT B Combination <br />TYPE D Demolitian <br />U Spri��.er <br />CONTRACT PRICE OF WORK � d p U _� O pp <br />i <br />� <br />� <br />� <br />PERMIT # <br />c o3o5-vaa <br />48�3 42s 3�ts�tti'Fr 1 <br />PHONE <br />�s �3�8'�t�l <br />ZIP CONTR. LICENSE il <br />�4 �i Of� � i1 � Sb ?� S g <br />Mechanical Addition HEA7 SOURCE <br />Plumbing WORK � AlleraUon �lectric <br />Sign TYPE C�'F�ew as <br />D RepaiAMaint. Other <br />CITY OF EVERETT LOCAL S/LLES TAX CODE IS 3105 <br />WORK DESCR�PTION RC�\c,��_� ¢�.K't�cw� � c�,t�,,�W� 4 c%.� ,e ,rr�p L w�� <br />� ` �1 \ <br />�[c�. w � � Sy� `�c c..a.7r � � �lSv..k.t�'tic� `� . — C'-� � �.c� -ax�S�"„� i-t'.Ii\� <br />U <br />\ cw-+""� `Q �.�.-�7?"'� W�+�w '��c ��S . '� `�jC �U.11 ♦ ��S'�'�� 1�1 'C„'� 'Q�'-'� . <br />NO. I T'�FE OF FIXTURE OR ITEM <br />WATER CLOS� iT (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />iAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICEIBAR/MOPIETC.) <br />OTHER <br />NO.. I TYFE OF FIXTURE OR ITEM <br />A/C—A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS R,4NGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER �n.�,rw�t+-. /F�1�}*'i^�c. <br />I HEREBY CERITIFY THAT I HAVE READ AND EX4MINED THIS APPLICATION AND KNOW THE SAME 1'0 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 GF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGUL4TING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERIY TO PERFORt,.7 THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />Signature of OwnedContractodAuthorized Agent Date <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />