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-- Un1iT J <br />P�RMIT APPLICATION `�� � �A' <br />CITY OF EVERETT PERMIT SERVICES ; <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8B57 � <br />SI7E ADDRESS <br />/ .r2 � <br />LEGAL LOT N0. <br />oesc. � Z <br />L�" � <br />BLOCK <br />��vlT '�Ow1EL�ul�d812 <br />TENANTNAME <br />CONTRAGTOR <br />C,ns <br />353 �aou <br />PROPOSED USE OF BUILDING <br />TRACT <br />�}�ll <br />PARCEL TAX I.D. # <br />(,�OODS <br />Sn! C • D (S oX /S% <br />CONTACT FOR PERMIT <br />PEF:MIT a I <br />cc�3�a-�c�:�� , <br />!� f' ON I <br />3s�-�ieuo <br />��z�� � _ � <br />PHONE I <br />ADDRESS 21P CONTR. LICENSE # <br />nD /S c,- /y-7°J � SNahtu»� r sN, u1H `9d'Zq/ cmrrnti,t�+�odsM 3 <br />Cxl ��leo/i�os <br />PF.RMIT <br />��-� �,,p�r �y� S i%' UCI TYPE <br />CONTRACT PRICE OF WORK � 6S u 00 <br />j� Building � Mechanical <br />�J Combination Plumbing <br />BDemolition Sign <br />Sprinkler <br />WORK DESCRIPTI <br />S�� �As�c zz �/y <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVA?�RY (WASH BASIN) <br />SHCiW E R <br />KITCHEIJ SINK 8 DISPOSAL <br />�ISHWF.SHER <br />LAUNDRV TRAY <br />CL07HE� WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DR41N <br />BACKFLOW PREVENTER <br />SINK (StRVICE/BAR/MOP/ETC.) <br />OTHER <br />Addilion HEAT SOURCE <br />Allerallon R Elec�nc <br />New qQ Gas <br />RepalrlMainL �� OOier <br />CITY OF EVERETT LOCAL SALES TA%CODE IS 7705 <br />N0. I TYPE OF FI%TURE OR ITEM <br />0 <br />� <br />�. <br />AIC — A/HANDLING �. NITS <br />FORCE� AIR SYSTLMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES ORYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLAGE INSERT <br />GASfIREPLACE <br />GASRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />i HEREBV CERITIFV THAT I HAVE READ AND EXAMINED THIS APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECi. ALL <br />❑ROViSiONS OF LAWS AND ORIDINACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPEC'FIED HEF'EIN OR <br />NO7 THE GRANTING OF A PERMIT DOES NOT PRESUh1E TO GIVE AUTHORITY TO VIOLA7E OR CANCEL THE PROVISIf)N OF ANV . TMER <br />STA fE OR LOCAL LAW REGULA7ING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV TME <br />OWNER OF THIS PRO ERTV TO PERFORM THE WORK FOR WHICH APPUCATION IS MADE AND I COMPLY WITM THE 5`ATE <br />CONT TORS LAW 8.27 RCW AND 296.200 WAC <br />�C� � • /L�3J D3 � <br />S�gnawre of wnedContractonAulhorized gent ate �'�, � <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTCD ' <br />