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SIIE ADDRESS <br />7 "13:. - �i � <br />LEGAL LOT NO. <br />DESC. 7�� <br />P�RMIT APPLICATIC�(V <br />CITY OF EVERETT PERMIT S�RVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />PARCEL TAX I.D. # <br />BLOCK TRACT <br />C"S l `�-'' f:N :�J <br />UI-uc,3. _ <br />PEj3�NiT � � <br />-��, �.�,. C;��/1-� <br />"'r' <br />I' A�a�{z..,�,��.v..�,w��, �.�.� ����a-�s���s� 3�� q�o«- �-Ids-iy3�17 <br />TENANT NAME CONTACT FOk PERtd1T PHOtJE <br />' L�{nS 1,c�SS��u �3-�'"l'f3-l'll� <br />V \ <br />CO TRACTQR ADDRESS ZIP CONTR. LICENSE # <br />���,��N�.�,�,��s�;;��� �7o3�-3S?`����.s� ���-�v��� �aoar�����a� <br />PHONE <br />PROPOSED IJSE OF BU�LD�NG <br />5 � r�\� . �m-""'si'\ <br />CONTRACT PRICE OF WORK <br />Building echanical <br />PERMIT �'Combination � iumoing <br />TYPE Demolition Sign <br />Sprinkler <br />Addition <br />Alteration <br />w <br />RepaidMaint. <br />HEATSOURCE <br />Electric <br />s <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CUDE IS J'105 <br />�, WORK DESCRIPTION � ��� �� ` <br />Cc1���ll,tic� lcm '1Lac�J <br />� . �%�)� / 7-� <br />'� M1Q, I TYpE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASIiER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKIiJG FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C—A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER , <br />RANGE HOOD m{�'�c� <br />WATER HEATER <br />YIETAL FIREPLACE/STOVE <br />FIREPIACE INSERT <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNON/ THE SAME TO BE TRUE FND CORRECT. ALL <br />?ROVISIONS OF LAWS AND ORIDINACES GOVERNING TMiS TYPE OF WORI( 6VILL BE COMPLIEO WITH WHETHER SPECIFIED HEREIN OR <br />^10T. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GVE Ali �HORITY TO VIOLATE OR C:.NCEL THE PROVISION OF :.NY OTHER <br />STATE OR LOCAL L1,W REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />pWNER OF THIS PROPERTY TO PERFORPd THE WORK FOR WHICH APPLICATION IS MADE AND I COPdPLY W ITH THE STATE <br />CONTRACTORS LAIN 1827 RCW AND 2S6.200 WFC. <br />DEBIT & CREDIT CARDS ARE NOT ACCEP7'ED <br />�Z <br />