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SITE ADDRESS <br />�Il <br />LEGA LOT N0. <br />DESC. <br />OWNER <br />�'C`I(% �'i��(.k' r <br />TENANT NAME <br />CONTRACTOR <br />��r�ERMIT i4PPLICAI �Ofl1 <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />�� —15��� }lve . �,�. . <br />� BLOCK I TRACT <br />ADDRESS <br />I4�c�S,l���i Sp,��'�� 1�l� <br />C TACT <br />� <br />ADDRESS <br />PHONE � y�I� L. <br />I1 �- <br />PROPOSEO USE OF BUILOING <br />S, j-. �,�_ . <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />J ,��C� I�l-t-1 f� <br />NO. I TYPE OF FIXTURE OR ITEN <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />IAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/tdOP/ETC.) <br />OTHER <br />I.D. # <br />�uilding �Mechanical <br />PERMIT ombination Plumbing <br />TYPE Demolition Sign <br />Sprinkler <br />J <br />a <br />PHONE �I ��JJ��J <br />—��.��� ��,�( <br />ZIP CONTR. LICENSE N <br />(�C�CTJ� �'3�NCa <br />F,X%�. iU/a.3�"�_ <br />RAddition HEATSOURCE <br />Alteration �Electric <br />RrNe�v Gas <br />v RepairlMaint. Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />NO. I TYPE OF FIXTURE OF ITEM <br />� <br />A/C —A/HANDLING UNITS <br />FO�CED AIR SYSTEMS <br />HEATPUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />PdETAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXADAIIJED THIS APPLICATION AND KVOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND OFIDIPJACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WI i 4 WHE7HER SF�CIFIED HEREIN OR <br />P:GT. THE GFANTING OF A PEflM1T DOES NO�i ?RESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />ST:.TE OR LOCAL LAVJ REGUIJ+TING CONSTRUCTiC^! OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHCRIZED BY THE <br />OVJtJER OF THIS PROPER7`/ TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CGNT��S LA' � 27 FC . AflD 296.200'NAC. �//� <br />� �l// <br />l�,t��( <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTEQ <br />��3 <br />