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SITE ADURESS <br />5 ��i� - <br />LEGFlL L0T NO. <br />DESC. , <br />OWNER <br />f-1 �,1,� c� <br />TENANT NA07E <br />6�ERI��IIT OaPPLICATION <br />CITY OF EVERCTT PERMIT SERViCES <br />3200 CEDAR S I REET, EVERETT, WA 9820 i <br />425-257-8810 — FAX 425-257-8857 <br />PARCEL TAX I.D. # <br />��l__ �3O�IC�16o.�oli <br />BLOCK TRACT <br />��-i� »A%�.,c�cAi �acy <br />AUDRESS <br />_,��.�� i'ic�,j��- �.:�E� <br />I CONTACT FOR PERMIT <br />PERMIT # <br />- ��i3 �-� -� � <br />PHONE <br />_ �) <br />I �-.� �s l_� :��,1��-�_ �la� -����,�-i "Il� <br />CONTRACTOR _ ADDR _SS 21P CONTR. LICENSE # <br />�-1 �.5� ry.��_ `�'.t,i.�_� _ � � � : - `�� ��..L ( 7 C '1� <br />���._.._. ,',•� -3� {�ur.5 � �i`n:n� }-�1�A�tzCi.i�:;�e i <br />PHONE <br />�l,"�_:� - j'-(;-1'lIR <br />PROPOSED USE OF BUILDING <br />�i���c�\.c `i'�:�•.r-1.1.'1:.J�! <br />1 <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTIC�N <br />Buildin� Mechanir.al <br />PERMIT Combination Plumbing <br />TYPE ' Demolition � Sign <br />Sprinkler <br />r�� �. � s , r.��.�. �;_���y ;,�,�_�i��.��- <br />, <br />NO. � TYPE OF FIXTURE OR ITEM <br />h WATER CLOSET (TOILET) <br />�- BA�HTUB <br />� L4VF�TORY (WASH BASiNj <br />_ SHOWER <br />_f_ KITCHEN SINK & DISPOSAL <br />�_ DISHWASHER <br />LAUNDRYTRAY <br />_j_ CLOTHES WASHER <br />URINA� <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOVJPREVENTER <br />SINK (SERVICE!BAF'!MOP/ETC.) <br />OTHER <br />rvPe <br />Addition I IIEATSOURCE <br />Alteration Electric <br />New �-Gzs <br />RepairlMainl. Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />6`� o-A. �-� � �` �,.3 `i <br />h7ECHAP <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C-A�'HANDLING UNITS <br />� FORCED AIR SYSTEMS <br />_ HEAT PUM? <br />UNIT HEATERS <br />1 CLOTHES DRYER <br />I 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 REA� AND EYAMINED THIS APPLICA.TION ANG KNOW THir. SAME TO BE TRUE AND CORRECT. ALL ' <br />�, PROVISIONS OF L4W5 AND ORIDINACES GOV'c��NING THI3 TYPE OF 4`10Ri( WILL BE COiti1F�_IEU WITH WHETHER SPeGFIED HEREIN CR � <br />, NOT. THE GRANTING OF A PERMIT DOES NOl" PRESUAfE TO GIVE AUTHORI7Y TO VIOLATE OR CANCEL THE FRO'JISION OF ANY OTHER � <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORA1Af ICE CF COYSTRUCTION. iHAT 1 AA1 AUTHORIZED B'! THE ' <br />' OINNER OF THIS PROPERTY TO PERFORM THE WORK FOR `NHICH APPLICATION IS MADc AND I COMPLY WITH THE STA7E <br />� CONTRACTORS LAW 18.27 RCW AND 296.200 VJAC. � i <br />I \ t <br />:� ����.��" .�.1 ��I� � I <br />SignaWr ofUwnedContractprlAuthonzedAgent Uet�— � i <br />�J � <br />I DEBIT & CREDIT CARDS ARE NCT ACCF.PTED C���o �ro�Y� I <br />