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SITE ADDRESS <br />fh <br />LO �NO. <br />P�RMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES , <br />3200 CEDAR STREET, EVERETT, WA 98201 � <br />425-257-8810 - FAX 425-257-8857 {� <br />1/w �nS- nn/� <br />BLOCK <br />c�S��E3�n""�-o -oz1—o� <br />J r I ZOZ-I�-OU <br />PERMIT <br />�',�ad -oo <br />OWNER AUURt55 cm rnvnc <br />98a�z <br />�r �' ) rl nl O> VC fLf� �13 � 5_�' "� � I,{ yv� V1� C. Iz Un r� 1� �'�-%e �� cc) lk <br />TENANTNAME � CONTACTFOR PERMIT PHONE <br />� I S� cUC (QZS1 '�Sd - Z07z <br />CONTRACTOR ADDRESS � ZIP CONTR. LICENSE fi <br />�"'�(uC-N �CMK 1.,An1DSVG�C /�315 STKUI'IAI'J�C ��,E�� <br />PHONE fsc%i���.l I.i%�YL 9go� z_ sTr_ d e7�5� K►�- <br />PROPOSED USE OF BUILDING <br />Building Mechanical <br />PERMiT � Combinalion R Plumbing <br />TYPE Demolition � Sign <br />Sprinklar <br />CONTRACT PRICE OF WORK �' .' ,_/� <br />WORK DESCRIPTION <br />7 .' L� <br />/�:�� s� ,�- <br />PLUMBIP <br />N0. I TYPE OF FIXTURE OR ITEM <br />Z WATER CLOSET (TOILET) <br />� BATHTUB <br />�LAVATORY (WA ;H BASIN) <br />SHOWER <br />� KITCHEN SINK 8 DISPOSAL <br />� DISHWASHER <br />LAUNDRY TRAY <br />� CLOI�HES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERV!CE/BAR/MOPIETC.) <br />OTHER <br />'� ' i '✓ � 1 <br />�. <br />Additlon I HEATSOURCE <br />Alteralion R Electnc <br />New �:Gas <br />Repalr/MaInL � l, Other <br />CITV OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />�� <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C -AIHANDLING UNITS <br />� FORCED AIR SYSTEMS <br />HEATPUMP <br />UNIT HEATERS <br />� CLOTHES DRYER <br />� RANGEHOOD <br />� WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />� GAS FIREPLACE <br />GAS RANGE <br />� GAS PIPING <br />EXIiAUST FAN <br />� OTHER <br />� I HEREBV CERITIFY THAT I HHVE READ AND E W+AIWEU THIS APPLICATION AMD KNOW TME SAME TO BE TRUE AND CORRECT. ALL <br />� PROViSIONS OF LAWS AND ORIDINACES ('yOVERNING THIS TVPE OF IVORK WI'_L BE COMPLIED VVITH WHETHER SPECIFIED HEREIN OR <br />' NOL THE GRANTING OF A PERMIT DOES NOT PRESU�JE TO GIVE AUTHOHIT( TO VIOLATE OR CANCEL THE PROVISION OF ANV OTHER <br />SThTE OR LOCA� W REGUL4TINf� G6NSiRUCT10DI�OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />�� OWNER OF THI OPERTV TQ PERFORAI THE �+�pkK FOR INHiCH APPU(.ATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACT AW 1fl27 R N AN 2°6,2001N�. <br />, / _ .' '9��,� _ <br />� V <br />� S�g�a[u � nn tori � thonzed Agent Date � <br />� DEBIT & CREDIT CARDS ARE NOT ACCEPTED � Z <br />