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SITE ADDRESS <br />�, <br />LE AL LOT N0. <br />DESC. <br />r} v � ��1 W <br />TENANT AME <br />�� <br />CONTRACTOR <br />�Ekiv"� � APPLICATIivN <br />CITY OF E�fERETT PERMIT �ERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />PARCEL TAX I.D. # <br />-�h `-1, . � � C� ��� �3i � <br />BLOCK TRACT <br />ADDRESS ZIP <br />� �� �-ZZ7 3��� S�f..'1:%��--S—f W.�WOCi'i` Lu�4-ISiZ.r1 <br />'� ___ � CON_TACT FORP�R.MIT � <br />------`-- _� ---.. <br />y-� � G 13Z� ma.tt� �wt�.�ic;.,�,wa1 <br />AODRESS S t�..-b'-� J�A{� ��� g ZIP <br />PI10NE <br />�o% • �lfl:�- • <br />PROPOSED USE OF BUILDING <br />� <br />PRICE OF WORK <br />WORK DESCRIPTION <br />-� l <br />Building D Mechanical <br />PERMIT R Combinalion I� Plumbing <br />TYPE Demolition U Sign <br />Sprinkler <br />� � /^ � <br />— '� � .'; . . --- <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHEFt <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />D�INKING FOU�JTAIN <br />FLOOR DRAIN <br />BACKFLOVYPREVENTER <br />SINK jSERVICE/BAR/MOP/ETC.) <br />OTHER <br /># <br />(� � �/Q 'U� % <br />P�10NE <br />CON'fR. LICENSE # <br />Addition <br />WORK Alteration <br />TYPE New <br />RepaidMaint. <br />HEATSOURC[ <br />ectric <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS :1105 <br />`�L'cJz�L � �J <br />NO.. I TYPE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEP'ERS <br />CLOTHES JRYER <br />RANGEHOOD <br />� WATER IIEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />� GAS PIPING <br />EXHAUSTFAN <br />I HEREBY CERi-i IFY THAT I HAVE FFAU AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF L4WS AND ORIDINACES GOVERNING THIS TYPE OF WORK 4VILL BG COMPUED WITH INHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING Or' A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROI':SION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />OWN R OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICA�iION IS MADE AND I COMPLY WITH THE STATE <br />C �ACTOR �� 1N�2 RC ND 296200 WAC. ��I �� O 3 <br />� r <br />Si naWre �f OwnedCo rac or/Aulhori gent ate � <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />