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P�RMIT APPLICATION <br />CITY OF EVERETT PE.RMIT SERVICES <br />3200 CEDAR STREET, Eb'ERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADORESS <br />1021 ►.l . �GWr-�wAY <br />LEGA LOT N0. BLOCN <br />DESC. c�yt s-ri-,� c..(t--.-�C7 <br />PARCE.L TAX I.D. N <br />2�051 "100203�00 <br />TRACT <br />PERMIT <br />�o�-�-I°� <br />_...._.. �pi6 ?�4TM ST' SW� SU Yl E A <br />i�l-+dlt-11�G �nr ��pMEl�Cf', LLG LYhltilWG��, WA. °.1803{o U25)"i'IS-5255 <br />TENANT NAME ' CONTACT FO'R PERMIT PMONE <br />`JOLVo-ttx�L f�_Nt'AL ANbY EiALL C42F�; 25�-G�8�5 <br />CONTRACTOR ADDRES9 ZIP CONTR. LICENSE N <br />cc�tt��1E Cohl�'T1O!-� I.LG I%10 L'�IGK{"O� AYE cG1eSTGL98'4KZ <br />PHONE }'}� �'C)i'� ZZBO �S�L�� <br />s�katin isH , wa . <br />PROPOSED U9E OF BUILDING <br />�LJ I f'M$NT /TUO L <br />t�t-ITAL }s4Ut�.lYY <br />'M'/'Sl' d!L.U!'AhlG1Ef� <br />Bulldind Mechanical <br />PERMIT �Combinalion R Plumbing <br />TYPE 4../ Oemolition D Sign <br />LJ Sprinkler <br />CONTRACT PRICE OF WORK .���(j p�, � <br />�AddlUon <br />Alteretlon <br />New <br />Repalr/Maint. <br />HEATSOURCE <br />�Eleclric <br />Gae <br />ome� <br />CITY OF EVERETT LOCAL SALES TAX CODE 19 3705 <br />WORK DESCRIPTION <br />-t�J-co�-fT- �r..��pvY�MENT o� AN �x�fihl�n 8,9i354,Ff'. <br />t�uit�F-�G, �t-cc�.upiN�, �at-t�.�.,a�it-1�.. <br />NO. I TYPE OF FIXTURE OR ITEM <br />' WATER CIOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAU�DRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVEN'ER <br />SINK (SERVICE/BAf:/MOP/ET(:.) <br />OTHER <br />NO. I TYPE OF FIXNRE OR ITEM <br />AfC - AIHANDLING UNITS <br />FORCED P.IR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />F�REPLACE INSERT <br />GAS FIREPIACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />I HEREBY CERITIFY THAT I HAVE READ AND EW+MINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORiDINACES GO�ERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTNORITV TO VIOLATE OR CANCEL THE PROVISION OF hNY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICM APPLICATION IS MADE AND I C�JMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 1,Q6.2C0 WAC. <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />