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P�RMIT AP�'LICATION <br />CITY OF EVERETT P�RMIT SERVIGES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE AODRESS <br />g�-�zl �8�' �'t�� u!-,-���� <br />LEGAL LOT N0. BLOCK <br />DESC. <br />OWNER — <br />C � ��s �=,L�z;�.�,% � <br />, <br />TENANTNAME <br />�,�� -rQr�,�✓ <br />ygLJ� PARCEL TAX I.D. # <br />�,-r oo ��aG oor o3 �a o <br />TRACT <br />ADDRESS ZIP PHUfJ q <br />� i�F � / Cyz��j %io_ 03 Zi <br />-I �c�—,¢G� L�.. c✓���� 9d'Za�r <br />CONTACi FOR PERMIT � PHONE <br />('rihi�, l�oR��tdti% �C.M1�� �yz��3S5—(�o0 <br />CONTRACTOR AUDRES ZIP CONTR. LICENSE # <br />�M1 l��rg�f(c.,j�YLf�1AiC DeQJ /�—%% q <br />PHONE SNO:�Ecr.�!S/-/. V✓!l} l�Za� l(/Lo/ZOoj <br />PROPOSE� USE OF BUILDING <br />G,�a,a d E <br />Bui:ding D Mechanical <br />PERMI7 � Combination I ) Plumb'ng <br />TYPE Demolition ❑ Sign <br />SFrinkler <br />CONTRACT PRICE OF WORK ��5 � 000 �� <br />�Additicn <br />Alteretion <br />NE'N <br />Repair/Maint. <br />HEAT SOUP.CE <br />Electric <br />Gas <br />Other <br />CITY OF EVFRETf LOCAL SALES TAX COOE IS 3105 <br />WORK DESCRIPTION <br />R����*��, �'�=a��r �,�--n/��--��n��.r-- �r `% � <br />� —� � . ,,-� - � .S � --- <br />j���;���Y��I 1 �f � L-c�����tr��c, <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />EATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHEB WASHER <br />URINAL <br />ORINKING FOUNTAIN <br />— FLOOR DRAIN <br />=I BACKFLOW PREVENTER <br />— SINK (SERVICE/BAR/MOPIE_'TC.) <br />— CTHER <br />mtc;n <br />NO. I TYPE OF FIXTURE OR ITEM <br />FVC—NHANDLING UNITS <br />FORCEC� AIR SYSTFNS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE !NSERT <br />GAS FIREPLACE <br />GAS P,ANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HERE9Y CERITIFY THAT I HAVE READ AND E;tAIdINED THIS APPLICATION AND KNOW THE SAME TO BE TRUc.4ND CORRECT. ALL <br />PROVISIONS OF L4WS AND ORIDiNACES GOVERKING 7HIS TYPE OF WORK WILL BE COMPLIED WITH `NHETHER SPECIFIE� HEREIN OR <br />NOL 7FiE GRANTING Or 4 PERMIT fJOES NOT PRFSUME TO GIVE AUTHORITY TO VIOLATE OR ^,A"ICEL THE PROVISION OF ANY OTHCR <br />STATE OR LOCAL L1W EGU WTWG CONSTRUCTION OR THE PERFORMv,NCc OF COP�STRUCTION. THAT i AM AUTHORIZEG BY THE <br />OWNER OF THIS PROP RTV TO PERFORM THE'�VORK rOR WHICH APPUCATION !S 1�7A�E AND I COMPCf WITH T4e STATE <br />CONT�TORS LAW .27 RC'JJ AND 256200'N4C. <br />.J <br />DEBIT 8 CREDIT CAR�S ARE NOT ACCEPTED <br />