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SITE ADDRESS <br />J � �1(J ' <br />LEGAL LOT N0. <br />DESC. i 2 <br />TENANTNAME <br />I-CRMIT /�PPLICATIUt� <br />CITti' OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETr, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />BLOCK <br />PARCEL TAX I.D. # <br />I �yJO�i�I Ub.i.' UU$'CU <br />TRACT <br />Q C''�'� <br />IIT # <br />��/' <br />-� _ _ <br />��.� l"lo3a-�5���.�_.� 3o�1�U..�94q�o�� �-las-��13�17i <br />CO TRACTQR <br />- cSZtL �R� C�N��S �I i-L C_ <br />PHONE <br />PROPOSED USE OF BU�L�ING <br />5� r.�\� Fm.,w.�.a�� <br />CONTRACT PRICE OF WORK <br />CONTACT FOR PERMIT <br />�--�-1 � �-� SS l <br />PHONE <br />�( a-� ' �('13 -1 � l � <br />ADDRESS ZIP CONTR. LICENSE # <br />�?o3a - 3 '���ES� �o�4-Q45v�a- 1�0 RrRr_ �o3a� <br />Building [�'�� echanical <br />PERNt1T Combination j�'�'lumbing <br />7vPE Demolition f� Sign <br />Sprinkler <br />WORK DESCRIPTION <br />Cm�S1'�.l�C� ltrr�\, 'V--�l� 'S-e-���� <br />\� <br />NO. I NPE OF FIXTURE OR ITEM <br />� <br />WATER CLOSET (TOILET` <br />BATHTUB <br />LAVATORY!\NASH BASIN) <br />SH01�'8R <br />N;ITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFL01h PREVENTER <br />SINK (SER4:CE/BAR/MOP/ETC.) <br />OTHER <br />Addition HEAT SOURCE <br />Alteration Electric <br />w 5 <br />RepairlMainL Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />J� <br />J/,C'/� �7� <br />�� <br />t�0. � TY?E OF fIXTURE CR ITEM <br />.F'✓G - WHANULING UNI I S <br />I FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />1 CLOTHES GRYER <br />1 RANGE HOOD 01��r <br />i WATER HEATER <br />METAL FIREPLACE(STOVE <br />FIREPLACE INSERT <br />� GAS FIREPLACE <br />� GAS RANGE <br />� GAS PIPING <br />� EXHAUST FAN <br />OTHER <br />I HEREBY CERITIPY THA i I HAVE READ ANO c"XAMINED THIS APPLICATION AND KNO'1J THE SHME TO BE TRUE AND CORRFCT. ALL <br />PROVISiONS OF LAlNS AND ORIDiNACES GOVERNWG TNIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREI�I OR <br />NOT. THE� GRANTING OF A PERMIT DOES N0T PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PkOVISION OF ANY OTHER <br />STATE OR LOCAL WW REGULATiNG CONSTRUCTICN OR THE PERFORA4ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNEr2 OF THIS PROPeRTY TO PERFORM THE WORK FOR 1NHICH APPLICATION IS MA�E AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED f I Z <br />