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m <br />SRE ADDRESS <br />,:.�; .� 7 Yl, , <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 GEDAR STREET, EVERETT, WA 88201 <br />425-257-8810 - FAX 425-257-8857 <br />PARCEL TA% I.D. A / �, <br />iA PE�OT J07� <br />LEGA LOTNO. BLOCK TRACT <br />oE�. �Et 'J �� � r)i�. ilE�('.({f .7TC:/�' I'1."►"i��(vI(".1� <br />OWNER AUDRES8 ZIP PNONE <br />��:��i <br />����� ��' � �7 ���- �' ('�1- /// "�' �`yf .�� %vrr�� f/ y�:��<3` =3y 7 �- (��= �'C� <br />TENANT NAME CONTACT FOR PERMIT P ONE <br />( �/.Z •: <br />y1-ln]� ,�'t �?� �2t/"� ��11-('i(�'�'' -- <br />CONTRACTOR <br />%t M <br />_ (�I,�:,) 3�1'�l-[ . <br />PROPOSED U8E OF HUILDIN6 <br />5�;,��l�c .�c,��iiyc <br />CONTRACT PRICE OF WORN <br />WORK DEBCRIPTION <br />ADDRE88 l, <br />j��"�� ��.1VI� J -� <br />�� rrr'tl ��'F� <br />BuMding D Mechanical <br />PERMR � Combinetion �j Plumbing <br />TYPE Dnmolilion U Sign <br />Sprinkler <br />LP CONTR. LICENSE / <br />�,., , �>cwr, �=r <br />Addilian HEAT BOURCE <br />WORK � Allerelbn � Elecirk <br />TYPE New Gee <br />RepeM/Meinl. Olher <br />CRV OF EVERETT LOCAL 8ALE8 TAX CODE IB NOS <br />/� � 1� �1(7�1 / . lll)C� ('1�C � )C����1 �('�;��i <br />� c l�l �Zi �� ��(��ii'��n�', <br />NO. I T�'PE OF FII(TURE OR REM <br />I WATER CIOSET <br />I BATHTUB <br />_� _ LAVATORY(WASH BASIN) <br />SHOW ER <br />KITCHEN SINK 8 DISPOSAL <br />- DISHWASHER <br />LAUNDRYTRAY <br />- CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />_ - FLOOR ORAIN <br />BACKFLOW PREVENTER <br />_ SINK (SERVICE/BAR/MOP/ETCJ <br />__ OTHER__ <br />_.1_._ �1IiLtLiC-.lv._i� �-�' 1���'!�. � .. <br />NO. I TYPE OF FI%TURE OR REM <br />A/C - AIHANDLING UNITS <br />FOP.CED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRVER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIRCPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />.--I _..—'_ —'__'__' _ <br />I HEREBV CERITIFV THAT I HAVE REAO AND EXAMINED THIS APRICATION AND KNOW iHE SAME TO BE TRUE ANOOUFRECT. ALL <br />PROVISIONS OF LAWS ANO ORIDINACES GOVERNING THIS 7VPE OF WORK WILL OE COMPLIED WITH WHETHER SPECIFIEO HEREIN OR <br />NOT THF GRANTING OF A PEF,MIT �OES NOT PRESUME TO GIVE AUT110RITV TO VIOLATE OR CANCEL THE PROVISION OF ANV OTHER <br />STA1E OR LOCM LAW REGULATING CONSiRUCTION OR THE PERFORMANCE OF CONSiRUCT10N. THAT I AM AUTHORIZED BV iHE <br />OWNER OF THIS PROPERTY TO PERFORM iNE WORN FOR WHICH APf'LICATION IS MA�E AND I COMPLV WRH THE S7ATE <br />CONTRACTORS LAW 18 Y7 C AND 296 400 WAC <br />� J � <br />. �,�i' �'� _ •.� iJ . 1 _ 7�'l�` -1 <br />DEBIT 8� CREDIT CARDS ARE NOT ACCEPTED <br />'IL <br />