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SITE ADDRESS <br />�q I'1 l °I'�' A� <br />LOT N0. <br />I"1dI8 Lw�Orr <br />�cRMIT APPLICAT��1N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, V1lr, 98201 <br />425-257-8810 - FAX 425-257-8857 <br />PARCEL TAX I.D. # PERMI7 # <br />00 +�13-��1 3�5 o i7 o z- � d3 b <br />BLOCK TRACT <br />,S-ti-02 r�vEc��r b�V 6t <br />�.-�QB�.�-c r�. �Nr'1aa�r( 2�2� ►Z.ocr.F�c.u.�a-Ave.���,on,cn `1g2o1 H25-158-62�_ <br />TENANTNAME CONTACTFORPERMIT PHONE <br />IvLA' ��>VI7 �LI.CXX_ - LWGJ'r y�"Z�q-�3lle� <br />CONTRAC1TO,R ADDRESS Z:P CONTR.LICENSE# <br />{�iC.f'�1Tb.'T F�-- �^no.�l�T'( <br />PHONE �ZS'25`D'CaZB� <br />PROPOSED USE OF BUILDING <br />�7lrJc-�t-E �a+N1�'( <br />I2rv,tl�k.��-�E.. <br />CONTRACT PRICE OF WORK <br />���{ R�Feu.Ee. 4uc. , Evear�cc,4�� 98to1 <br />nBuilding <br />PERMIT � Combination <br />TYPE Demolition <br />Sprinkler <br />WORK OESCRIPTION <br />b�r-to l-�O�,.s�-C'o F�^,.:r�b-<<«�1, <br />N0. I TYFE 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 WAShcR <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />RMechanical <br />Plumbing <br />D Sign <br />C�� <br />�� <br />� <br />Addition <br />Alteralion <br />New <br />RepairlMaint. <br />HEATSOURCE <br />Electric <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />NO.. � TYPE OF FIXTURE OR ITEM <br />A/C—AIHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLAC[/STOVE <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AN�` EXAMINED THIS APPLICATION AND KNOIV THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES G.IVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NUT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTR:ICTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AA9 AUTHORI2ED BY T4E <br />OWNER OF THIS PROPERTY TO PERFORM TI1E WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />Signature of OwnedContrectorlAuthoiized Agent Date <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />