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!-cRMIT APPLICATII�.N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA °8201 <br />425•257-8810 - FAX 425-257-8857 <br />SITE ADDRESS Q PARCEL TAX I.O. # I �� ,�j`� `v3 � <br />�404 Cveo . Wu a a,�°��e�" i`Fx20 003�i 3� o010o q� o�_ ���«� <br />�EG ggVERLY HO�tE TRACTS DN 2 BLK 00! D•02- ALL OF LOT 4& 5 LYW OF ST RD 1 SE 70FI' OF <br />�ESC. LOT 6 LESS S 387 FT THOF ALSO LESS E 150Ff OF S 487FT OF L01'S 4,5, 6 LY1y OF ST RD <br />OWNER AGDRESS ZIP PMONE <br />bis�, tG.,;,l� (r.��p L�C �► o3ex k�o �'1�k�l�loo,u9A q�a�� <br />TENANTNAME CONTACTFORPERMIT PHONE <br />?. .� �_ �.,��,�� �,m.�, � 5���� S�al4�Q� y� s �a� �`t41 <br />CONTRACTOR <br />w. Q. Nahso., T ne. . <br />PHONE���. 8 �I�-�—�A�"� <br />o� -� <br />AODRESS <br />Iol5l0 i 3oT" ��,•,e l�l� <br />lC.�l�l4.,�, W A °��034 <br />PROPOSED USE OF BUILDING <br />L� PERMR <br />L7Cn:t., O�C�G� S��i'� TYPE <br />CONTRACT PRICE OP WOHK �� n0 OO� <br />Build(ng � Mechanical <br />Comb(nalion Plumbing <br />DemotiGon Sign <br />Sprinkier <br />LP CONTR.LICENSEII <br />wa-�-�A-r�*-kdsla� <br />AtlCition <br />qnarnuon <br />Now <br />Repa!qMaint <br />HEATSOURCE <br />�Elecuic <br />Gas <br />ONer <br />CITY OF EVERETT LOCAL SALES TAX CODE IS �105 <br />WORKOESCRIPiION � . • � .} <br />lnU��,l�c.��on et `� Clna••- �e,.��c.� 5�,��f� �..,�..c.�.. �nc��Je� (�ecep �oit! <br />=,�{Q�.1�2G.'i'On, O'c�.r�c fcc.N�G.�U �C.b. <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />(WASH &1SIN) <br />SINK 8 DISPOSAL <br />CLOTHES 1Nl� <br />URINAL <br />DRINKING FOL <br />FLOOR DRAIN <br />BACKFLOW PF <br />SINK (SERVICI <br />MECHANICAL �,5�,�„� <br />NO. I 1'YPE OF FlXTURE OR REM <br />A/C - NHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUIdP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL F�REPLACFJSTOVE <br />�IREPIACE INSERT <br />23NS FIREPLACE <br />I HEREBY CERITIFY THAT 1 HA4E READ AND EXAMINED THIS APPLICATION AND KNOW TNE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF lAWS AND ORiDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WH�TFiER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMR DOES NOT PRESUME TO GNE AUiHORITY TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CANSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR tiYHICH APPUCATION IS MADE AND I COMPLY WITH THE STATE <br />CANTW�CTORS LAY� 18.27 R�ly AND�98200 WAC. <br />�� �_l%� _ �i/ L - � �-0 5 <br />mzed Agent �ate <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED �/2 _ <br />