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SITE ADURESS <br />'.E�.;�� LOTNO. <br />_)E5 , 7 <br />l ( <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERV{CES <br />3200 CEDAR STREET, EVERETT, WA 9d201 <br />425-257-8810 — FAX 425-257-8857 <br />TRACT <br />� y <br />nNS��.22�1 <br />(�� ��-� a) <br />PARCEL TAX I.D. # PERhtIT o <br />_ �iz -a� <br />C ,�:.� f-,,�•� i;uicJLli,�. //l�: _�D �vX /•5 I� � f��,,�i.lr1, `1�=9/ �l?j_3:i�1 -/,.��c� <br />. tic � <br />TENANT"4ME CONTACTFORPERMIT ' PHONE <br />�i:Nr� /✓/C/:/Zile..l �-fz.r�� 7-: 000 <br />CONTRACTOR AODRESS ZIP CONTR. LICENSE 11 <br />S�I�..F /I S Q�dNc� <br />PHONE <br />_ C,,,ir�� ����,`—jr3 <br />PROPOSED USE OF BUILDING I IS7� Duilding � Mechan��C81 I AGdilion HEAT SOURCE <br />PERMIT Combinahon Plumbirg WORK Alteration Eieanc <br />� I TYPE � Demolilion Sign ITYPE New � Gas <br />•S ��� U Sprinkl�r RepaiuMa�nt. L� Otner <br />CONTRHCT PRICE OF WORK � CITY O�' EVERETT LOCAL SALES TA% CODF 13 71P5 <br />%, 000 <br />WORK DESCRIPTION <br />�J.. ,�T, �, C i A.' f•- �� .� F'/\ <br />NO. � TYPE OF FI%TURE OR ITEM <br />� WA1�ER CLOSET (TOILET) <br />� BATHTUB �J r/C wC�2 <br />.S LAVATORY (WASIi BASIN) <br />SHOWER <br />= KITCHEN SINK 8 DISPOSAL <br />f_ DISHWASHER <br />— LAUilDRY TRAY <br />i CLOTHESWASHER <br />URINAL <br />DRINKING FOUNTAIN <br />i FLOOR DRAIN <br />BACKFLOW FREVENTER <br />_I SINK (SERVICE,BAR/MOPiETC.) <br />OTHER _ <br />NO. I TYPE OF FI%TURE OR ITEM <br />A�C — A/HANDLING UNITS <br />� FORCED AIR SYS�FMS <br />= HEATPUMP <br />UNIT HEATERS <br />I CLOTHES DRYFR <br />—� RANGE HOOD <br />I WATER HEATER <br />METAL FIREPLACEISTOVE <br />FIREPLACE INSERT <br />�_ GAS FIREPLACE <br />GAS RANGE <br />� GAS PIPING <br />� EXHAl�ST FAN <br />OTHEP <br />: hEREBV CERITIFV THAT i HAVE REAC AND EYAMINED THIS APPLICATION AhD KNOW THE SAME TO BE TRUE AND CORRECT A�.� <br />PRO\'ISiONS OF LAK'S AND OftIDINACES GOV3R"'^IG THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER �PECiFIED nEREiN 0• <br />fJC i TME GRAN7ING OF A PERh11 i� DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF Alvv C7neR <br />SthTE OR LOCAL LhW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION THAT I AM11 AUTHORIZED DV 'HE <br />O'.NNER OF TMiS PROPERTV TO PERFORM TNE WORK FOR IYHICH APPLICATION IS MADF AND I CUMPLV WITH THE STATE <br />CCPiTRACTORS LA1Y 1d1i RCYV AND 296 200 WAC. <br />C3 <br />DEBIT & CREDIT CA :uS .4RE NOT ACCEPTED <br />`ly <br />