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PERMIT APF'LICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRE55 <br />��I, <br />LEGAL LOT NO.� I � <br />DESC. <br />OYJNER <br />�/' \ <br />TENANTNAME <br />CONTRACTOR � - <br />I�c%� C.Cn r ; <br />PHONE <br />PROPOSED USE OF BUILDING <br />S F:Z <br />CONTRACT PRICE OF WORK <br />WORK OESCRIPTION <br />_� � � <br />` '� � .. <br />_, - <br />BLOCK I TRACT <br />PARCEL <br /># <br />��c(JUUoC� �L'G�S '— <br />�,�i3 - a �c� <br />CONTACT FOR PERMIT <br />ADDRESS <br />��D•�Z S 1'rJ L <br />�,.7 t�r��T� '011v <br />PERnMIT/»/ <br />C.� 7�� ��! � <br />ZIP PHONt II\ S <br />/ S+- 2-( S rf.r . �, kz � <br />Building echanical <br />PERMIT Cumbination lumbing <br />TYPE Demolilion Sign <br />Sprinkler <br />� 'I ✓ '.�o �` .� � � <br />NO. I TYPE OF FIXTURE OR ITEM <br />� WATER CLOSET (TOILET) I <br />� BATHTUB <br />LAVATORY (1,'JASH BASIN) � <br />' SNOWER <br />I KITCHEN SINK & DISPOSAL <br />� DISHWASHER <br />LAUNDRYTRAY <br />� CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />rL00R DRAIN <br />_ BACKFLOW PREVENTER <br />_ SWK(SERVICE/BAR/MOP/ETC.) <br />-}:,�r �, �,,; c <br />TYPE <br />PHONE <br />ZIP CONTR. LICENSE � <br />IJ-"ICG: i��-. �� J`� .`�� � I— <br />Addilian <br />�ration <br />New <br />RepaidMaint. <br />HEATSOUFCE <br />Electric <br />Gas <br />Other <br />CITY OF EVERETT LOCl.I. SALES TAX CODE IS 3105 <br />�C ��� � � <br />MecH.an <br />NO.. I TYPE OF FIXTURE OR IiEM <br />A/C - A/HANDLING UNITS <br />I FORCED AIR SYSTEMS <br />HEAT ?UMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />I RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />� GAS FIREPLACE <br />1 GAS RANGE <br />� GAS PIPING <br />� EXHAUST FAN ���� <br />OTHER <br />v' <br />i HERE9Y CERITIFY THAT I H4VE READ AND EXFMINED THIS APPLICATiON AND KNOW TNe SAME TO 9E TRUE AND CORRECT. ALL <br />?ROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS T'PE OF WOP.K WILL BE COMPLIED WITH WHETHER SPECIFIE� HEREIN OR <br />NOT. THc Gi.AN i ING OF A PERMIT DOES NCT PRESUME TC GIVE AUTHORITY TO VIOI.ATE OR CANCE! THE PROVISION OF ANY OTHek <br />STATE OR LCCAL WW REGULATING CONSTRUCTION OR THE PERFORMANCE CF CONSTRUCTION. THAT I A�1 AUTHORIZED dY THE <br />OWNER OF THIS ?fi0 n i O P`tRFORM THE INORK FOR WHICH APPLICATION 13 MADE AND I COMPLY LVITH THE STATE <br />CONTRHCTORS XAVJ 18.27 CW AND 296.2�0 4V,9C. , . - <br />CREDIT CARDS ARE NOT ACCEPTED <br />N <br />