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P�tRMIT APPLICATIGN <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 />/� � f S w <br />LEGAL LOT NO. <br />�e�l � �o� )�"��c�elG'�� <br />TENANTNAME <br />/'�d7'�Q <br />CONTRACTOR � w`1 P �,... <br />PHONE <br />PROPOSED USE OF BUILDING <br />�c1rc1 % �' <br />PARCEL TAX I.D. # <br />4Y?GocS�d <br />9LOCK I TRACT <br />. � ti ,� f.� �. y�l <br />CONTAC(T' FOR PERMIT <br />l�vh )�ry«la�� <br />ADDRESS <br />p�j Building <br />PERMIT [� Combination <br />TYPE D Demolition <br />U Sprinkler <br />00 <br />Sl 5�5� <br />a <br />y u' 2 s'L �/ 33 <br />PHONE <br />yz,— zsz Y33% <br />RMechanical <br />Plumbing WORI <br />D Sign TYPE <br />ZIP ' CONTR. LICENSE # <br />j'7 Addition <br />}�{ Alteration <br />{ � New <br />U Repair/Mainl. <br />HEATSOURCE <br />�ElecUic <br />Gas <br />Other <br />CONTRACT PRICE OF WORKN j� G� �' .�,��'� G �U I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION �Z �y z [�. -F� � �..l� � ^ �vr� / c � �`•° '� �� f. �. � t-�.'/.t <./ !/ oYrrt S � a <br />LXt� u;ac: c?s�3 jr4 S�na��/�,�.�� � 21I'�S�l-%!P�/ �jtiac'� SG�.//�s- <br />Np. I TYPE OF FIXTURE OR ITEM <br />W.1TER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <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 (SERVICEIBAR/MOP/ETC.) <br />OTHER <br />NO. I TY1`E OP FIXTURE OR IiEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAM1IINED THIS APPLICATION AND KNOW THE SAA1E 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 OF A PERMIT DOES NOT PRESUM11E TO GIVE AUTNORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />S7ATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CON�TRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CON1�tACTORS LAW 'I8.27 RCW AND 296.200 WAC. <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />