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��ERMIT APPLICAI��ON <br />CITY OF EVERETT PERMIT �ERVICES <br />3200 CFDAR STREET, EVERETT, WA 98201 <br />425-257-8t110 — FAX 425-257-8857 <br />�, SITE ADDRESS /�,�( I_� I I n�l� ����• �� I• /�� I�^�0 <br />"� a � ll U U <br />��. LEGA LOT N0. ,�/ BLOCKI TRACT <br />DESC. �� <br />FK <br />�, TENANT NAME <br />CONTRACTOR /��;�D L'�tr K, I�vC . <br />` <br />PHONE��I��,�\��I �/ <br />J 1 �J" <br />I PROPOSED USE OF BUILDING <br />il <br />� S �. �Z . <br />�i CONTRACT PRICE OF WORK <br />' WORKDESCR�PTION <br />, I ��(` �t�1r� <br />I r�uiwnin <br />�, NO. I TYPE OF FIXTURE OR ITEM <br />, _ WATER CLOSET <br />_� BATHTUB <br />� LAVATORY (WASH BASIN) <br />SHOWER <br />� KITCHEN SINK 8 DISPOSAL <br />� DISHWASHER <br />LAUNDRYTRAY <br />I CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />_ FLOOf, DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHEF <br />io S�Ive�Sp�,ru <br />CONTACTNAME ' <br />���� ��ll�l���� <br />AODRESS <br />�� vo <br />1�il L> �l ve �' S�(�r�C�S l�(Cr <br />PERMIT <br />TYPE <br />�Building � Mechanical <br />Combination Plumbing <br />Demolition Sign <br />Sprinkler <br />,�ia,S /G, <br />�, �18a��. (��� <br />PHONE <br />a � <br />% -f> J <br />33�� -593� <br />� f -�935 <br />?il _ 7LL��n <br />ZIP CONTR. LICENSE M <br />���a3 co��c.��o3aNr� <br />CxP. lola�lv3 <br />Addition <br />WORK Alteralion <br />TYPE New <br />Repair/Maint. <br />HEATSOURCE <br />�Electric <br />Gas <br />Other <br />CITY OF EVEREff LOCAL SALES TAX CO�E IS 3105 <br />22�� <br />n <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C — A/HANDLIN ; UNITS <br />� FORCED AIR SYS�EMS <br />HEAT PUMP <br />UNIT HEATERS <br />I CLOTHES DRYER <br />I RANGE HOOD <br />� WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />� GAS PIPING <br />� EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAP�11NE0 THIS APPLICATiON AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF WWS AfdD 7RIDINACES GOVERNING THIS TYPE OF WORK WILL 6E COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PEF�AIT DOES NOT PRESUFdE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIUN OF ANY OTHER <br />STATE OR LOGAL LAW FiEGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OW�dER OF THIS PROPERN TO PERFORId THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH'iHE STATE <br />cnrJTRACF6$ LAW 1827 RC`N ANq,29§200 WAC. , . <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />� <br />