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PERMI'�' APPLICA.1 ION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVGRETT, VJA 98201 <br />425-257-8&10 — FAX 425-257-8857 <br />SITE ADDRESS <br />5 �� �5- n r�, �.1 ��. i.v <br />LEGAL LOT NO. � BLOCK <br />DESC. � i'� <br />TRACT <br />U l <br />PARCEL TAX I.D. # <br />`����Il�lUO ^-ulo0o <br />�1��3//- caS'� <br />PERMIT # <br />�nei<<�Y� ri��. 17�>j� '3S �'"1'��c �� I3.fb�(� wti �f S':�IZ �/2S'-7yS l7/,�' � <br />i <br />TENANT NAME CONTACT FOR PERMIT PHONE � <br />� ;.� I_�ti�f;�.� c/ZS -7,.,3-1�1y I <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE # I <br />{�jp�t,�- L4�. i��•.r: �s,�. ,�„� 5� 9s;�t , <br />PHONE �IZS jcl3 I713' i�nArR�I.C'C ��I <br />PROPOSED USE OP BUILOING f�� �ulldifl9 Mechanical Addi�ion HEAT SOURCE <br />f�ERMIT j7j Combination v�Plumbing WORK � Alleration (� Electric <br />Sr`� 7YPE Demolilion Sign TYPE New Gas <br />B Sprinkler RepairlMaint. uu,sr <br />CONTRACT PRICE OF WORK CIN OF EVERETT LOCAL SALES TAX CODE IS J705 <br />WORK �ESCRIPTION <br />NO. I TYPE OF FIXTURc OR ITEM <br />1 <br />C <br />� c; <br />i _ •L <br />WATER CLO�ET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SIR!K & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASIIER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />6ACKFLOW PP,FVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />I <br />NO. I TYPE OF FIXTURE OR ITEM <br />NC—A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HE.4TERS <br />CLOTH�S DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS F!REPLACE <br />GAS RANGE <br />GAS PIPI�G <br />EXHAUSTFAN <br />i I HEREBY CERITIFY THAT I HAVE READ AND EXFAII�ED THIS APPLICATION AND KNUW THE SAMc TO BE TRUE AND CORRECT. ALL <br />� PROVISIONS OF LAWS AND URIDINACES GOVERP:iNG THIS TYPE OF VJORK INILL �E COMPLiED INITH WHETHER SPECIFIED HGREIN OP, <br />� NOT. THE GRANTING Or A PERMIT DOES IJOT PRESUh4E TO uIVE AUTHORITY TO VIOLATG OR CANL'EL TF:E PROVISION OF ANY OTHER <br />� STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />I OWNER OF THIS PROPERTY TO PERFORAI THE'�NURK FOR SNHICH APPLICATION IS A1ADE P.ND I COMPLY WITH ,'HE STATE <br />�� CONTRAC70RS LAW 18.27 CW AND 296.200 bVAC. <br />'� l'I,> f1 ��.._. ��_� � i-L�l - L�,� <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />%� <br />