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SITE ADDRESS <br />S�s?�— <br />_E�A,` LOT NO. <br />J_SC.� 1 � <br />TENdNTNAME <br />_ _ _ --- — - — -- — — ---- ----- -- <br />F��RMEI' APPLICATIUN <br />CITY OF EVERETT PERMIT SERVIC�S <br />3200 :;EDAR STREET, EVERETf, WA 9$201 <br />425-257-8810 - FAX 125-257-8857 <br />�''` Aue l� • <br />I BLUCK I TRACT <br />CONTRf�ACTOR <br />� �c6.L1. �iy�•�¢A,�,Z.LRiA� I,:-l`_ <br />PHONE <br />PROPOSF.O USE OF BUILDING <br />�,.�G.. F o-�,..�.�:�t <br />. /L4.1-�c.4� <br />CONTRP-CT PRICE OF WORK <br />1NORK DESCRIPTiON <br />� <br />PARCEL TAX I.D. # <br />I U'a+ - J� tt lt�e <br />CONTACT FOR PERMIT <br />1.-.� ►J l-eS J I' <br />lib3�-3�/�U.�S� <br />--� <br />PERhtfi p <br />PNONE <br /><t �..5 • l �l3 -�s`� <br />ZIP CONTR. IICENSE k <br />�c?�1�.�.`� 9Yti�7— �-1DA�RE�-c3sa�� <br />ildi�g ^�;`�,,� echanical <br />PERMIT ombinalion � Ylufnbing WORI <br />1YPfl D¢mOli60!1 Sign TYPE <br />Spnnkler <br />� � �4— � ��1 <br />J�.i.1,t�s--�� <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ <br />'NA'fER CLOSE? (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SH04YER <br />KITCHEN SINK 8 DISPOSAL <br />DISMl'iFSHER <br />LAUNORYTRAY <br />CLOTHES'NASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR JRAItJ <br />BACK'rL0`N PREVENTER <br />SINK (SEr�VICElBAR/MOPlETC.) <br />OTHER <br />�ddiuon <br />ateration <br />evr <br />Repav/1.1amt. <br />HEATSOURCE <br />Eic[tn[ <br />,a, <br />othcr <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS 7105 <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - A/HANDLING UNITS <br />� fORCED AIR SYSTEMS <br />H�AT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />�dETAI FIREPLACElSTOb'E <br />FIREPLACE INSERT <br />� GAS FIREPLACE <br />GASRANGE <br />:� GAS PIPING <br />EXHAUST FAN <br />OTHER <br />�^EREB'I CER171F/ THhT I h!AVE REHO FND E:V+�AINED THIS hPPUCATION iiND KIJOW THE $AME TO BE TRUE AND CORRECT. ALL <br />� RClISiONS OF LFWS AtlD ORID�PIACES GOVcRNING THIS TYPE OF WORK WILL BE COMPLIED WITH LNHETHER SPECIFIEO HEREIN OR <br />'�Oi i Nc GRAPITING OF A PERfdIT �OES tlOT PRESU�dE TO GIVE AUTHORI'Y'f0 VIOLATE OR CANCEL THE PROVISION OP FNY OTHER <br />SSATE GR �OCAL lnY/ REGULFTING CONSTRUC i ION OR THE PERFOR�AANCE OF CONSTRUCTION. THAT I Aid AUTHORIZED BY THE <br />7:lNER OF THIS PROPERN TO PcRFORM THE YlORK FOR'NHICH APPUCATION 13 IdADE AND I COMPLY WITH iHE STATE <br />��:ONTRFCTORS f.A'N iB27 RClJ ANO 246.200 VlAC. <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />