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SITE ADDRESS y L j <br />r,,... rr <br />LEGA LOTNO. <br />�r.c� d- <br />TENANTNAME <br />�NERMIT APPLICA'� iON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-B857 <br />- 9ti t� st s � <br />wA. 9 ta� <br />BLOCK TRAOT <br />CONTRACTOR M 1 <br />� N'�Ii �I�I ( I`�SIO/AI��Oh <br />PHONE <br />4a5'• ffrZ-793� <br />PROPOlED USE OF BUILDIN6 <br />CONTR�CT PRICE OF WORK <br />WORK DEBCRIPTION <br />'�► �-e �(Q'i''aif�- <br />NO. I TttPE OF FIXTURE OR 17EM <br />.f <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNURY TR,4Y <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />PARCEL TAl( I.D. M <br />L3-9Yt5 S� <br />NTACT F011 PERNIIT <br />ADDIlEBs <br />�svs /SYitAv• Nr <br />ry/�/ . c u,�F Fsgs <br />,.J� ..J �n q�osL <br />Bullding DMechenical <br />PERMR B Combinatbn B Plumbinp <br />TVPE D Demolitlon Sipn <br />L� Spdnkler <br />PERMIT N <br />E o308-4� <br />4�s'-i�1-6}r1 <br />9tr��y <br />PNONE <br />ZIP CONTR. LICEN6E � <br />�kc�,�nstsr7�p <br />Additlon I HEATlOURCE <br />a�erauo� Ebctrlc <br />New � l3ae <br />RepalrlMalnL Otl�er <br />CITY 0° EVERETT LOCAL DALE6 TAX CODE 1� �105 <br />SaS�'nc� -� �.�.0 <br />� ,�: <br />�-� <br />NO. I TYPE OF fll(TURE OR ITEM: <br />A/C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP ' <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/ST4VE <br />fIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPINO <br />EXHAUST FAN <br />Ol'HER <br />�� r- <br />� � <br />I NEREBY CERITIFV THAT I HAVE READ AND EXAMINED THIS ANPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TY'E OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AJTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTMER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTP.UCTION. 1'F1AT i AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO P�tFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTf1ACTORS LAW 7827 RCW AND 298.200 WAC. <br />-L2-D) <br />DE811' 8 CREDIT CARDS ARE NOT ACCEPTED <br />