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SITE ADDRESS <br />�L- Zll - ' <br />LeGALI LOT N0. <br />DESC.� �'� <br />AcQ a� (z.. � �n• <br />TENANTNAME <br />%l <br />�r'ERMIT APPLICATIUN <br />CITY OF EVERETT P�RMIT SERVICES <br />3200 CEDAR STRGET, EVERETT, VVA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />Pa.se�, �,-�,.c <br />CO TRACTQR <br />�c$La�2 'C�`a�T21S� 1_�� <br />PHONE � <br />I PRGPOSED USE OF BUILDING <br />S� r�\�, �'�o.,� <br />GUN I KAG I PRIGE OF WORK <br />PARCEL TAX I.D. # <br /># <br />� �28o��Ul-oe3--oo�_Go �o,P. ���� � <br />TRACT — <br />GI�Y1�oc6?_ CQc���} <br />ADDRESS ZIP PHONE <br />l'1�3a--�v����.5� �Vo-�SQ qSsota- �-lds-7�{3�17 <br />CONTACT FOR PERMIT PHONE <br />��nl 1_ � SS �� �i a-J ' "l �l 3 - t �7 ( � <br />ADDRESS ZIP CONTR. LICENSE # <br />�'lo3a -3 �q,�ES� �a�-�YBo�a� AO�Rr �o3a� <br />Building echanical <br />PERMIT �Combination �lumbing <br />7YPe Demolition Sign <br />Sprinkler <br />Addition <br />WORK Aiteration <br />7YPE w <br />RepairlMaint. <br />HEATSOURC[ <br />Electric <br />s <br />Olher <br />CI1Y OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />wvltK UtSGftIPIION <br />CCl\c`�'t�1.1/��F ltr`f�� �V�-4-1� J-�,�.'T�x-�-- ��^^-�+� J� <br />u � <br />i NO. <br />� <br />:� <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />IAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />F�OOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BARIMOPlETC.) <br />OTHER _ <br />NO. I IYpE OF FIXTURE OR ITEM , <br />A/C — A/HANDLING UNITS <br />� FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />� CLOTHES DRYER . <br />i RANGE HOOD I%�inc.:� <br />l WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />l GAS FIREPLACE <br />� GAS RANGE <br />�a GAS PIPING <br />� EXHAUSTFAN <br />OTHER <br />7, <br />i HEREBY CERITIFY THAT I HAVE REAq AND EXAMINED THIS APPUCATION AN� KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK 6l'IL� BE COMPLIED WITH SNHETHER SPEGFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUh1E TO GIVE AUTNORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAV�' REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTNORIZED OY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE ANO I COMPLY WITH THE STATE <br />CONTR4CTOR5 LAw �8.27 RCW AND 29s2nn wac <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />