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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 />SITE ADDRESS PARCEL TAX I.D. M P <br />=�g�"j� l`�c.�vl�ratl.— OCv392$-PUfo-C7l4-o0 � <br />LEGAL LOTNO. BLOCK GTR�A�CT 5`%� <br />�ESC. ~I � 1 W �.�C'E."rt' �``�'fV'] � . � /'TY%✓%� <br />C✓2.ov-+ti QE.v��c�Qwi�,��' ��'='J ( 1'1 - 55� ,�iJC ��L� <br />TENANTNAME r � �/� J CONTACTFORPERMIT <br />�('`JC��V �v��l�"1 _"W1 W I � �/9'�-1 ��l.1+C <br />� <br />CONTRAC, T� �� <br />PHONE �� �/7 S� <br />� � / �f <br />PROPOSED USE OF BUILDING <br />\�.%� J�E t-�J S �, <br />ADDRESS <br />uilding [� Mechanical <br />PERMIT Ombinati0n U PlUmbing <br />TYPE Demolitian U Sign <br />Sprinkler <br />CONTRACT PRICE OF WORK �� ` O�G <br />NE �_� <br />ZSZ �Z-I 5 <br />ZIP CONTR. LICENSE # <br />Addition <br />Alteration <br />New <br />RepaiUMalnt. <br />HEATSOURCE <br />Electnc <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />WORKDESCRIPTION �1`� � ���LS� � ��� �jQ ('j' O� <br />U�,F.G� /��z�. ,� ��I �-s �v�UJY`'� <br />NO. � TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />1$ITCHEN SINK & DISPOSAL <br />LAU RY TRAY <br />CLOTH WASHER <br />URINAL <br />DRINKING FO TAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />NO. I TYFE OF FIXTURE OR ITEM <br />A/C -AIHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOV� <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />i HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPIICATION AND KNOW THE SANE TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIE!) WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REG TING CONSTRUCTION OR THE PERFORMANCE OF CONST�U::TION. THAT I AM AUTHORIZED BY TFIE <br />OWNER OF IS PROP T PERFORM TNE WORK FOR VJHICH APPLICATION IS Ml,.'E nND I COMPLY WITH THE STATE <br />CONTRAC ORS LAW .27 W AN4 Z96.200 WAC. <br />� <br />�� <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />