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i _ _- i <br />l <br />PERMIT AF'PLICATIO�1 <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 />s �i S <br />LeGA LOT NO. <br />�r» A�� � <br />BLOCK <br />A-DA-ii2 c.t-TGYLpizcscs4 <br />TENANTNAME <br />CONTRACTOR <br />I�PJfS/�'SU... /���✓+ 6 <br />PHONE _ L563%K07-7Vb` <br />PROPOSED USF CF BUILDING <br />i� <br />PARCEL TAX I.D. # <br />TRACT <br />CONTACT FOR PERMIT <br />ADDRESS <br />in-L <br />a933� i��nr ,4-v� ,�t <br />�---�� .4lL� xle'Yz'ti <br />Building D Mechanical <br />PERMI7 �Combination U Plumhing <br />7YPE Demolition U Sign <br />Sprinkler <br />CONTRACT PRICE OF WORK c�-Z S�� <br />WORK DESCRIPTION <br />� NSJ�9s� �2� <br />NO. I TYPE OF FI:CTURE OR ITEM <br />WATER CLOSET (TOILE'i ) <br />BATHTUB <br />IAVATORY (WASH BASIN) <br />�HOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR Df2AIN <br />BACKFi'�W PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />PERMIT # <br />Ko�(oa-oo <br />ZIp PHONE <br />PHONE <br />ZIP CONTR. LICENSE # <br />n�g.,.,v-� Z�Z� <br />g�2z 3 <br />n Addilion <br />�-1 Alteralion <br />H New <br />L/ RepaidMaint. <br />HEATSOURCE <br />Elrclric <br />Gas <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />S'/�2 i.-,C L CZ4 C"' / h� N G 6V s�n <br />NO. I 7YFE OF FIXTURE OR ITEM <br />A/C-A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />FIEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />/�Ls�i.�7 S <br />i HEREBY CERITIFV THAT I HAVE READ ANO EXFMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINFCES GOVERNING THIS TYPE OF VJORK WILL BE COMPLIED WITH WHETHcR SPEC!FIED HEREIN OR <br />NOT. THE GRANTING OF h PERMIT DOES NOT PRESUM1dE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATIOPJ IS MADE AND I COMPLY WITH THE STATE <br />COMTR �� i W E.27 AND 29620� VJFC. <br />� —z/z-l.� �s� <br />Sig�re of OwneriContracror/Authonzed Agent ' Date ���1 <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />