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SITE ADDRESS <br />i u i� _�L'' <br />LE�A LOT NO. <br />Df iC. I b J l`1 <br />OWNER <br />�,�I V �� i ��I s <br />TI?NAh!T NAME <br />��RMI� APPLIGAi'I�bJ <br />CITY OF EVERETT PERMIT SERVICES <br />32G0 ",;EDAR STREET, EVERE('T, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />PIiJ I�S tJb� <br />_ PAFiCEL iAX I.D. # P MIT aj�� <br />� �?'a2-OO..��b,a� � IJ'-�/ ✓ � 1 � <br />✓ �J�Z-O'vJ - ,V � d )J�2-ClJ -019�J� � <br />BLOCK TRACT <br />7..,- ..� .� ;�,..., fl. , _ Q� i <br />� <br />CONTRACTOR <br />�/FUfiC. J�C� �la�a.�14:�nel� Lll <br />PhO� IE <br />�-(L�- $�V'3-C�14� <br />PROPOSED USE OF BUILOING <br />CONTRACT PRICE OF WORK <br />WORK DESCFIPTION <br />C��-tS�-r;1,e� � A <br />?LUMBIN( <br />N0. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />CiSHWASHER <br />V�UNDRY i RAY <br />CLOTHES WASHER <br />URIN�L <br />DRINKING FOI;NTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR�MOP/ETC.) <br />OTHER_ _ <br />.0.3a�, 2S <br />CONTACTFOR <br />�r�.i E j� <br />ADDRESS <br />� J. '%s. Z�� 1 � e�e�4'�� <br />Building Mechanical <br />PERMIT Combination Plumbing <br />TY;�E Demolition � Sign <br />Sprinkler �r�rx��+,� <br />a.� � � <br />Ora�u����, .rRa�� <br />�12i -��• � y �I -1 <br />aHONr. <br />�2a-S'Oj3 -�ilv�e3 <br />ZIP CONTR. LICENSE H <br />cl S �j�3 <br />;%��UhU � Ct�1�Cl <br />Additian HEAT SOURCE <br />WORK� Alteration � Eleclr,c <br />TYPE New Ges <br />Repai,iMainL Olher <br />CITY OF EVEREIT LOCAL SpLES TAX CODE IS 3105 <br />i-a;L �i,t•un��� ����l�iw���.i i <br />W,v.���X , <br />NO. I TYFE OF FIXTUAE OFi ITEM <br />� <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEATPUMP <br />UNIT HEATERS <br />CLOTHES DRYEP. <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPf.P,CE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CEP.ITIFY TNAT I HAVE READ AND E:(AMINED THIS APPLICATION AND KNOW THE SAME TO BE TqUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br />NOT. THE GFANTIIJG OF A PERMIT DOES NOT FRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OF LOCAL LAW AEGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I N� AUTHORIZED BY THE <br />OWNER OF THIS PROPERTI' TO PERFGRM THE l'lORK FOR WHICH APPLICP'ION IS MADE AND I COMPLY N'ITI i THE STATE <br />CONTRACTORS LAN' 18.27 RCW AND 296.200 WAC. <br />Signature of OwnedContractodAuthorized Agent Da�e �I� <br />� DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />