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P�CRMIT APPLICATI�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRE55 <br />lla/G 9S'N <br />_c"OFL' LOT NO. <br />^_5�� 6 <br />��iYI'T ��W1tLSGl�� <br />TENANTNAME <br />CONTRACTOR <br />�,�� r <br />r S � <br />BLOCK TRACT <br />PHONE <br />z� 1 3i 3-yaoo <br />PROPOSED USE OF BUILDING <br />%v,:%.. %-�C.�Sc (Or.)S�7:L�.i'(i <br />�S F rZ� <br />PARCEL TAX I.D. # <br />��Gus,—ri �•`eoo.ti <br />-I'^1 � . �d Q o,Y /S7 <br />I CONTACT FOR PERMIT <br />uN�-� <br />p��.,� �s3BA <br />'7F�t�•=�f�" <br />PERMIT a <br />�U3i.� -�i <br />'HON <br />'y+., 3st-yeuo <br />wi��f/, oJA R�'��� -- <br />PHONE <br />AOORESS Z`P �ON���E*O$S"�''� <br />po G on i; �y , iN���.,, ��N, �H ��'e l� 7 <br />GKj� il�iJ�L:oS <br />Building Mechanical <br />PERMIT � Combination � Plumbing <br />7YPE Demolition U Sian <br />Sprinkler <br />CONTRACT PRICE OF WORN �{ �5� � 00 <br />WORN DESCRIPTION <br />_SF'Q ��s �� <br />NO i NPE OF FI%TURE OR ITEM <br />TYPE <br />('� AnOition <br />�� AiteraUon <br />�! New <br />u ROpair/Maim <br />HEATSOURCE <br />Eiectrt <br />Gas <br />01^e� <br />CITY OF FVERETT LOCAL 9ALES TAX CODE IS ]1G5 <br />Lz�i-� � ,l°l��^ o.ti��� <br />�� <br />�y� <br />_S _I VJATER CLOSET (TOILET) <br />2 BATNTUB <br />3 I V+VATORY (WASH BASIP!) <br />SHOWER <br />=�i KITCHEN SINK & DISPOSAL <br />L I DiSiiWAS�iER <br />�,LAUNDRYTRAY <br />��� r_t.OTHES WASHER <br />_ i �IZiNAL <br />— , pRINKING FOUNTAIN <br />_/_; FLOOR DRAIN <br />_! ;BACKFLOW PREVENTER <br />_; SWK (SERVICE/BAR/MOP�ETC.) <br />,r,7HER <br />N0. I T�'PE OF FIXTURE OR ITEM <br />:JC -A/HANDLINGUNITS <br />Z FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />� CLOTHES DRYER <br />� RANGEHOOC <br />� WATER HEATkR <br />METAL FIREPIACE/S70VE <br />FIREPLACE INSERT <br />7 GAS FIREPLACE <br />GA:i RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />GTHER <br />�-EAE9� CERITIFY THAT 1 h.1VE READ AND EkAMINED THIS APPI ICATION AND KNOW TME SAME TO BE 7RUE AND CORREC i AL', <br />_��': �5'ONS OF tAtVS 4ND ORiDiNACES GOVERNING TMIS NPE OF WORK WILL BE COMPLIED WITH WnETMER SPECIFiE� HERE�.� CF <br />,._" '^E �3RAN71NG OF A PERM1IIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL TME PROVISION OF A�ti�� Ci-E� <br /><'r'. ::� ,CCAL LAW REGU'�1TING CUNSTRUCTION OR iHE PERFORMANCE OF CONSTRUCTION THAT i AM AUTHOPo:FD B� "�c <br />��-, � r;EP GF'h•5 PROPE➢7�i T� vERFORM THE WORK FOR �M1'HICH APPLICAiION IS MADE AND I COIdPLV WITM THE S?ATE <br />._'."��j-'O�S �FC; 1��7 RC�V an� 296200N'AC <br />/L/3J /0 <br />'/z <br />DEBIT 8 Ci2EDIT CARDS ARE NOT ACCEPTED <br />