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SITE ADDRESS <br />� �_� �' /�T�l <br />I FGALI LOT NO. <br />C �I ��S FILeZ�mn,J <br />P�R11�ffIT APPLIrATiO�I <br />CITY OF EVERETT PERMlT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-88 � 0- FAX 425-257-8857 <br />�xl�`i <br />�"3-, �✓ ��2�17 <br />TENANTNAME <br />� N/L!1 I'� abY�n A.�l <br />CONTRACTOR <br />�.Ki l�^-���g�r«W �21, �Nc <br />PH�NE <br />PROPOSED USt OF BUILDING <br />6���a¢E <br />PARCEL TAX I.D. # <br />C� <br />TRACT <br />(cP' �'�/� i L�� <br />� <br />'HON q <br />��Z, -7�0- 03 zi <br />CONTACT FOR PERMIT � PHOPIE <br />�',2h��S I'✓lo�,t�l�.�l �C..v��-j �yz� j�s' S —rvoo <br />ADDRES ZIP CONTR. LICENSE # <br />�0 tQJ�C /5 %`� �Zq� f� Lo Zuo� <br />sNo��S�f, ��} 9 1 / <br />Buiiding D Mechanical <br />PERMIT � Combination U Plumbing <br />7Yi�E Demolition U Sign <br />Sprinkler <br />CONTRACT PRICE OF WORK }��7 � pQ0 <br />Pddition HF.AT SOURCE <br />WORK � Alleration Eleclric <br />TYPE New � Gas <br />Repair/Maint. Other <br />CITY OF EVERETT LOCAL SALES TAX Guut is ��u5 <br />WORK �ESCRIPTION i - � <br />R�,��,��� � �h�� � � �a N�-� ti ���.� ;�9s <br />c;� <br />NO. I TYFE OF FIXTURE OR ITEM <br />— WATER CLOSET (TOILET) <br />BATHTUE <br />LAVATORY (WASH BASIN) <br />-- SHOWER <br />KITCHE� S!NK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASIiER <br />U R.I NAL <br />DRINKING FOUNTAIN <br />FLOOR DRA�N <br />BACKFLC`: � :'F.�VEN i ER <br />- -- SINN (<i,=KviCE/E.'�4:r+lOr/ETC.) <br />= � UTFi[R------ <br />� <br />N0. .I TYPE OF FIXTURE OR ITEhi <br />A/C —AIHANU�INIi UIVI I J <br />PORCF� AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />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 CERIiIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE I;.JE AND CORRECT. ALL <br />PROVISIONS OF IAWS AND ORIDINACES GOVERIJING THIS TYPE OF WORK WILL 6E COMPLIED \NITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRA�di ING OF A PEr^.�d1T DOES NC7 PRESUME TO GIVE AUTHORITY TO VIOLATE OR CP.NCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW EGULATING CONSTRUCTION OR THE PERFORAIANCE O� CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROP RTY TO PERFORM1! THE 1NORK fOR WHICH APPLICATIO� IS MADE AND I COMPLY WITH THE STHTE <br />CONT�TORS LAW .27 RCW AND 29fi.200 WAC. <br />�� �/gl�� <br />DEBIT & CREDIT CARGS ARE NOT ACCEPTED <br />