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SITE ADDRESS <br />c �-,{��- - I <br />LEGAL LOT NO. <br />DESC. <br />owNea <br />Cc� � �L=EK,1.� <br />TENANT NAME <br />r��RMIT APPLICA'r iON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FP,X �+25-257-8857 <br />NVQ. � � <br />BLOCK ,--� TRACT <br />CONINACTOR ��/'�I I` / ��%�� <br />VL J l, 4.� <br />PHONE��� )�`�� ����� <br />i/ <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />WORK DESCRInPTION <br />,J� � � � <br />NO. I TYPE OF FIXTURE ON ITEM <br />—� <br />� <br />u <br />ADDAESS <br />I� <br />rax i.o. <br />� <br />PHONE <br />�� 22� I �; <br />ZIP CONTR. LICENSE N <br />� H�� a��9� <br />Building Mechanical <br />PERMIT Combination R Plumbing <br />TYPE Demolilion � Sign <br />Sprinkler <br />/� ��-� �- �a�3 <br />WATER CLOSET <br />BATHTUB <br />IAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER _ <br />Adtlition <br />Altoration <br />New <br />RepaidMaint. <br />HEATSOURCE <br />Electric <br />Gas <br />Other <br />CITY OF EVEREfT LOCAL SALES TAX CODE IS 3105 <br />M <br />N0. I TYPE OF FIXTUAE OR ITEM <br />A/C — A/HANDLING UNITS <br />� FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATEP.S <br />�CLOTHES DRYER <br />RANGEHOOD <br />� WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />I GAS RANGE <br />�GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATIGN AND KNOW THE S4ME TO BE TRUE AND CORRECT. ALL <br />PRCVISIONS OF LAWS AND OFIDINACES GOVERNING THIS NPE CF 4VORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES IJOT PRL=SUME TO GIVE HUTHORIIY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAI L:.W REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHO�IZED BY THE <br />OWNER OF THIS PROPERIY TO PERFORP,1 THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />COIVTRACTO S J8.2�RCW PND296200 WAC. � <br />� ;�s���' � � �\� <br />Signature of O SenCa t ctor/Authorized Agent Da e � <br />L <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED _ <br />