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PERMIT APPLICAiI <br />, CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETi', WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRESS <br />DESC. <br />OWNER <br />1�c+�A�i✓'[-' <br />TENANTNAME <br />CUNTRACTOR %-'i�''e�� j Fi•PC•' <br />/T'.2t7 i EC > �Oi.O <br />PHONE z53 - 9 yG- ZZSJ <br />PROPOSED USE OF BUILDING <br />PERMIT <br />�D (J 70 S E�✓/L � TYPE <br />/-'/a �/C/ T�a <br />PARCEL TAX I.D. # <br />ADDfiESS <br />5/ %� <br />CONTACTNAME <br />ADDRESS Z 7� 7 7 O� <br />A ✓� � <br />`A Gu n,/J� �-✓A <br />�Bullding Mechanical <br />Combinatlon R Plumhing WORK <br />Demolilian p Sign TYPE <br />Sprinkler <br />PERMIT # <br />kaar�7-ol <br />PHONE <br />PHONE <br />CONTR. LICENSE k <br />P.oT-?ir�°a 49c� <br />9E �2`f <br />Addltion HEAT SOURCE <br />Allomlian (� Eleclric <br />aw F� Gas <br />Repair/Mainl. LJ Othor <br />CONTRACT PRICE OP WORK � 2(%. �j o-C� ,� I CITY OF EVERET LOCAL SAL[S TAX CODE IS 3105 <br />�'NORK DESCRIPTION / <br />,�,2 y P�,�c S/�.e/�t/.C�LE ,e sys � E-� F�-e <br />�/CW f} ✓ j a 5 C2 ✓/c � f'A G/G / T� <br />NO. � TYPE OF FIXTURE OR ITEM <br />� <br />WATER CLOSET <br />RATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />IAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREV[NTER <br />S�NK (SERVICE/BAR/ OP/ "i C.) <br />OTHER_��� LE /,/G-%i/JS <br />N0. � TYPE OF FIXTURE OR ITEM <br />AJC - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <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 EXAMINED TH'S APPLICATION AND KNOVG THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND OR�DINACES GOVERNING THIS lYPE OF WORK WILL BE COh1PLIED WITH 1YHETHER SPEC�FIED HEREIN qR <br />NOT. THE GRANTING OF A PERMIT DUES NO�f PRESUME TO GIVE AUTHORITI' TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />'ATE Ofi LOCAL I.AW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />,VNER OF THIS PROPERTY TO PERFORM TI1E WORK FOR WHICII APPLICATION IS MADE AND I COAIPLY WITH THE STATE <br />CONTRA�ORS LAW 18.27 RCW AND�96.200 WAC. <br />�•�-U7-dl � <br />�� O <br />