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SITE A�DRESS <br />LOT <br />�ERMIT APPLICAT�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />Cv+x.t}- <br />�l F�Lo <br />BLOCK TRACT <br />PARCEL TAX I.D. # <br />Q -Ob <br />O/Sc��--�..•7� %.+tis�— <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />Pa�� c�- K�i:a.s,��-,�, p��� 1��„r �C�i.:� �YZs�Zs�-sZSL <br />CONTRACTOR /A�DDRESS 1�6oj�--1b'�'�j,x_ W Z�P CONTR.LICENSE# <br />�^ti %✓0.'�r�A.l � ' �- %�-t �f �aiu � �-� �2�h54 '�' <br />PHONE � `C�vv�o.a..CiS �1�'O7-� C-�ooa�lLoZi'j <br />i �(L�'1'� if — 299 � <br />PROPOSED USE OF BUILUING <br />o��+�L o-�:�c.� <br />Buiiding Mechanical <br />PeRMIT B CombinaUon Plumbing <br />TYPE g Demolition ign <br />Sprinkler <br />CONTRACT PRICE OF WORK �pP�X � � So0 <br />WORK DESCRIPTION � r (� <br />S:S,,,,. -� Sj- 0•-'+7�� -W -1"OCcw.d.L o..�. <br />S a•�if.ar�- �+orl � o� Q.�r s�e o iL S �: I <br />NO. I TYPE OF FlXiURE OR ITEM <br />WATER CLOSET (TOILE� <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICEIBAR/MOP/ETC.) <br />OTHER <br />Atleition <br />aterauon <br />New <br />RepaidMaint. <br />HEATSOURCE <br />�Eledrfc <br />Gas <br />olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C-AlHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHO00 <br />WATER HEATER <br />METAL FIREPLACE/STO�E <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />i HEREBY CERITIFY THAT I HAVE READ AND EW+MINED THIS APPLICATIOPI AND KNOW THE uAME TO BE TRUE AND CORR:CT. 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 PERh11T DOES NOT PRESUME TO GIVE AUThJRITY TO VIOLATE OR CANCEL TNE PROVI£�ON OF AtJY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296100 WAC. <br />/ ec�oi�t'f"' <br />2 <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />�L <br />