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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />200 EDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITEADDRESS <br />go lf), S�- S tt7 <br />LEGAIJ LOT NO. I BLOCK <br />PARCEL TAX I.D. N <br />Cx�7 Zci 3mDooCo caU <br />TRACT <br />PERMIT M <br />'YI cj3) 2-03 <br />UWNeN <br />lei-n fdLj VAI K yo I $q 7'' s�jc �,4# q2w� V253�16 3e�3 <br />TENANTNAME CONTACT FOR PERMIT PHONE <br />CL MLe j4/(4(g1,w �jCo 2di�7� <br />CONTRACTTOR LL-- { „ �,� AODR Z1P CONTR. LICENSE N <br />(%4 S�ltt� i7rry E� y crawl Too /Ca- cI 1 �/ { /J <br />PHONE , w—�..� &fA-.fHhEC97/OK <br />4EJ,0 0 ccu <br />Building <br />Addition <br />HEATSOURCE <br />PROPOSED USE OF BUILDING <br />PERMIT <br />IMechanigcal <br />B Combination Plumbin <br />WORK <br />{R( Alteration <br />Elecnlc <br />TYPE <br />Sign <br />TYPE <br />L.i New <br />Gas <br />BDemollllon <br />Sprinkler <br />U 9epairlMaint. <br />Other <br />CONTRACT PRICE OF WORK '�Q �l <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 31e5 <br />____--- <br />WORN DESCRIPTION <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />WATERCLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK(SERVICEISAR/MOP/ETC.) <br />OTHER <br />_UNIT <br />Z <br />— <br />— <br />— <br />— <br />— <br />AIC- AIHANDLINGUNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />S <br />OTHES <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/ VE <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NCT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW CONSTRjCTIONOWNER OF THIS PROPERTY TOTPERFORM THE WORKOFOR WHICH APPLICATION IS MADETHE PERFORANCE OFRAND I COMPLY WITH THE SOTATE D BY THE <br />[CNTRACTORS LAW iR.27 RCWNO 18[ WAC. . , / z <br />t ",7av7n Q_,Ot/%C� K17/6.3 <br />4?-S- 77 o 3 ZH DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />T'd L9BBLS2S26T:01 <br />:W08A 8£:80 £002-6T-330 <br />