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j SITE ADDRESS ,� <br />� __1���'`__�_� <br />; LFGM_� LOT NO <br />�. C)[SC.� �i <br />r�ERMIi APPLICA'� �ON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />BLOCK <br />PARCEL TAX I.D. # 3ot� <br />C <br />�C� P�RM�Tp <br />C �' ;//- �''-� <br />i i7���11_���l-,�--.�71J�J1�'-�.-. a.l,U�_��r�v��-�-y,���� ��o,����� -od3.� <br />iTENANT NAME CONTACT FOR PERMIT PHONE <br />--- I �r,ec4 LNra,�a,cy� (3��, 6sa -� d �f — <br />I CONTRACTOR AODRESS ZIP CONTR LICE_I�SOE�o� <br />.����Pr�' ll�o <br />i PHONE �AME T*S _�N1=� ._—___.__. _ .. — ---I��S ` I i q O N� � <br />I PROPOSFD USE OF AUILOING Bmlding � Mer,hanical j�� AdAihon HEAT SOURCE <br />I PERMIT � Combmalw�i PlUrtiblfly IWC�RK � Alleration � Elecinc <br />i C L�� TVPE Demolilion Siyn TYPE New Gas <br />J � ` Sprinkler RepaiuManl I Olher <br />� ____— ___-- _. _____. _______ . <br />� CONTRACT PRICE OF WORN CITY OF EVERETT LOCAL SALES TA% CODE IS J105 <br />WORH OESCRIPTION / � ' <br />/6'Fu� S �� ,�'br• � �src �� �� <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITFM <br />WATER CLUSFT (IOILETI <br />DATH7UFi <br />LIIVATORV �WASH B�SIN) <br />SHO',NFR <br />KITChif_N SINK 8 DISPOSAL <br />DISHWl1SIIFR <br />I.nUNDRYTRAY <br />CLOIHES WNSHER <br />URINAI <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />B�CKFLOW PREVC-NTER <br />SINK �SERVICErE�AR/MOP�ETC.) <br />UTHER_ _ <br />NO. I TVPE OF FIXTURE OR ITEM <br />A/C — NHANDLING UNITS <br />_[ FORCED AIR SYSTEMS <br />HEAT PUiv1P <br />UNIT NEATERS <br />� CLOTHES DRVER <br />/ RANGEHOOD <br />_L WATER HEATER <br />METAL FIREPLACE/STOVE <br />f-IREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />�GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBV CERITIFY 7HAT I HAVE REAU ANU EhAMiPlEU THIS APPLICATION AND KNOW THE FAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS ANU ORI�JINACES (iOVFRNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPFCIFIEO HEREIN OR <br />NOT THE GRANiING OF A PFR�11T f10E5 NOT PRESUME TO GIVE AUTHORITV Tp VIOLATE OR CANCEL THE PROVISION OF ANV O1HER <br />STATF OR LUCAi _;,W REGULAT WG CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION THAT I A�1 AUTHORIZED BV THE <br />OWNER OF FH�S PROPERTI' TO PERFORM r{1E 6YORK FOfi WHICH Af•PLICATION I5 MAUE AND I COMPLY WITH THE STATE <br />CONTRA(�ORS L/1W 18.�/�CVyAND 296201�NAC ` / <br />DEBIT 8 CREDIT CAROS ARE NOT ACCEPTED I�� <br />