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c <br />I��RMIT' APPLIrATION <br />GITY OF EVERETT PERiV[IT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />�erti.,f C G3!l-G`i <br />� SITE AD ESS / <br />So � <br />L_GA LOT NO. G� BLOCK <br />Ieesc. <br />OWNER <br />}�fo�u �Y� [����. <br />TENANT NAME <br />� CONTRACTOR �A D_�-� ���+ <br />�`I <br />PHONE �� ZS" 'y 3� �� � S/ <br />PROPOSED USE OF BUIL�ING <br />S�{Z �- �-«��.�� <br />I��.�..a <br />CONTRACT PRICE OF WORK <br />WORK OESCRIPTION <br />� PARCFL TAX I.D. # PERMIT # <br />� ZSfUyUlvv2c�l�oo C�s;c �- <br />TRACT �� � � �� � <br />t �i wcu� � <br />17u32 75�t`b��z s� !3v�'hall ��80iZ ��Zs"-7�;3-17�y <br />CONTACT FOR PERMIT PHONE <br />L-�h L�s51��i ti2S-�u3-�� �8 <br />ADDRESS 21P CONTR. LICENSE # <br />i��3z 3s"�"!-.a�� sk ygo�Z r?��,,�Cio,2c� <br />���'''Byyy ilding � Mechanical <br />PERMIT �COmbination �'Pfumbing <br />1YPE D Demolilion Sign <br />U Sprinkler <br />Aadition <br />WORK Alteration <br />TYPE New <br />Repair/Mai�t. <br />HEATSOURCE <br />�Electric <br />� Gas <br />Olher <br />CITY OF EVERETf LOCAL SALES TAX CODE IS J105 <br />5� �\ "_' J� CI�• �\/�L. �1� Lv\\tiL`l 1./1l-..�-1 t�i.�.\ ` <br />� <br />N0. i TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LA�:ATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES W �HER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BARlMOP/ETC.) <br />OTHER <br />� <br />II <br />NO. . I TYPE OF FIXTUF.c OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HFATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER _ <br />I HEREBY CER:TIFY THAT I HAVE READ AND EXi.MINED 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 •.VHETHER SPECIFIED HERFIN OR <br />NOT. THE GR:{N71NG OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOL4TE OR CANCEL THE PROVISION OF ANY OTIiER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONiTRUCTION. THAT I AM AUTHORIZED BY THE <br />O'lJNER OF THIS PROPEP.T'/ TU PERFOR�d THE WORK FOR WFiiCH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW �827 RC�D 296200 WAC. <br />-/i�'�i.E"; !i_..i,. I I-I�' ' US <br />DEBIT 8 CRF_DIT CARDS ARF NOT ACCEPTED <br />Vv <br />