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SITE ADDRESS � <br />/Z ZZ'— <br />LEGAL LOT N0. <br />DESC. <br />OWNER <br />� <br />/ ���s G <br />TENANTNAME <br />CONTRACTOR <br />aHOH�GmRS li� <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />P�RMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />£ V �,' PARCEL TAX I.D. # <br />v� 9gzo/ y3q Y7s-o31oe� <br />BLOCK TRACT <br />ADORESS <br />+RH /�' ��o �% .$` �il ✓L� /Va i <br />-� I CONTACT FOR PERMIT <br />ADDRESS <br />/G/ 7 <br />5-'�q v t �✓a.��� <br />Building <br />PERMIT � Combination <br />TYPE Demolilion <br />Sprinkler <br />3 ,S� <br />WORK DESCRIPTION n <br />�F.H'lQ h K-i�MG'l� � � <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER 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 (SERVICE/BAR/MOPlETC.) <br />OTHER <br />BMechanicai <br />Plumbing <br />D Sign <br />ZIP <br /># <br />- bo% <br />Z�G-�t3 <br />3z.z3 <br />PHONE <br />CONTR. LICENSE!! <br />Addilion I HEATSOURCE <br />Alleration R ElecMc <br />New �j Gas <br />Repair/Maint. U Other <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br />G�, . �r�-� � f , <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UN� iS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RAWGE HOOD <br />WATER HEATER <br />METAL FIFtEPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPIACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATIOtJ AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVIuIONS OF LAWS AND ORIDINACES GOVERNIN6 THIS 1YPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING �F N PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIOIJ OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I Atif AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH NPPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RC1dLANfYi96.200 VJAC. _ i <br />%�t o�y <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />