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FcRMIT APPLICATIUN <br />, CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERE f7, WA 98201 <br />� 425-257-8810 - FAX 425-257-8857 <br />� SITE ADDRESS <br />�i'1 T5 — c��;'. <br />� LEGAL LOT N0. <br />� DESC. 3i <br />� ,,. ,. <br />�I A cQ ai (z. � <br />I TENANTNAME <br />A� <br />BLOCK <br />PARCEL TAX I.D. # <br />� ��OG'{G1'UGJ,-UO$"E�C <br />TRACT <br />vl�N�:-�`c4 `V�i <br />�. <br />s�, 1,-�..c t'lo3a--3����5� �vc�1u9.� e��o�a- �-lds-i�13�17 <br />CO(N�TRrA�CTQR <br />F-1- CX0.12 ir�;1�l��lS C�jji �L 'L <br />PHONE � <br />CONTACT FOR PERMIT <br />L..i� I��ssl <br />ADDRESS <br />PHONE <br />�i3�j'"1�13-1i1� <br />ZIP CONTR. LICENSE # <br />�"103� -3 ���eSE ���i�.s9_yso�a- iaof-�Rr �o,a� <br />PROPJSED USE OF BUILDING � BUilding �dechanical Addition HEAT SOURCE � <br />S, ���� �� PERMIT �Combination Plumbing WORK Alteiation Electric � <br />TYFE Demolition Sign TYPE w s I <br />Sprinkler RepaidMaint. Other I <br />CONTRACT PRICE OF WORK CI1Y OF EVERETT LOCAL SALES TAX CODE IS 3105 ; <br />WORK DESCRIPTION - n � � <br />C cl���llr�e-` lo^�. � '1�-4-1�.� 5-Q-�u---�� `�.Acy.l�S <br />��/� / �S, <br />i <br />—L <br />� <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILEI') <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOVJER <br />KITCHEN SINK & DISPOSAL <br />DISH�VASHER <br />LAUNDRYTRAY <br />CLOTHESN;ASHER <br />URINAI <br />DRiNKIPJG FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICC-/BAR/MOP/ETC.) <br />OTHER <br />�,� <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 -(n�2�� <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />i hEREBY CERITIFY THAT I HAVE REAU AND EXAMINED THIS APPUCATION AND KNOW TNE SA�dE TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND OkIDINACES GOVERNING THIS TVPE OF WORK lNl�l BE COMPL!ED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. i HE GftANTING OF A PERMIT DOES NOT PRESUME TO GiVE AUTHORIN TO VIOLATE OR CANCEL TNE PROVISION OF ANY rTHER <br />STATE OR LOCAL Li�W REGULATING CONSTRUCTION OR THE PERFORM1IANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF 7HIS P�ROPERTY TO PERFORAI THE WORK FOR WHICH APPLICATION IS titADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCIY AND 296."<00 WAC. <br />DEBI',- & CREDIT CARDS ARE NOT ACCEPTED <br />��• <br />I/�. � <br />� <br />