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SITE ADDRESS <br />��LEGAL LOT N0. <br />/�w G1'l�r c <br />TENANTNAME <br />�ERMIT APPLICATIVN <br />CITY OF EVERETT PERMIT SEP.VICES <br />3200 CEDAR STREET, EVERETT, WA 9i201 <br />425-257-8810 - FAX 425-257-8857 <br />PARCEL TAX I.D. # <br />� vP� �fl f�k 1 � � <br />—� BLOCK ACT <br />o r� /Yla c <br />,3hD�l�i.te .����f/-e <br />ICO� T FOR PERMIT <br />V C//c.�ivi <br />S� �✓� o%�����✓ /�/c.� <br />,��-� S /-/66 / <br />PROPOSED USE OF BUILDING <br />�'P l �l I l <br />CONTRACT PRICE OF WORK � <br />WORK DESCRIPTION <br />�0��+'7?�/C <br />7 <br />/8'/ d-o6—.5�6 <br />PHONE <br />i�� S'�-�" /-/6G / <br />7���VP �a ZIP %U i� fEN5g8 <br />/ 'SC� <br />f�P�r �Jid- cl�f�3� <br />wlding Mechanical <br />PERMi7 Combination R Plumbing <br />TYPE Demolition D sign <br />Sprinkler <br />� <br />�/Z < ' L./F3 � � � ��i9 /n% 4� <br />v <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB !� G �'e <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 (SERVICE/BARIMOP/ETC.) <br />OTHER <br />Addition <br />WOPK �le2Aon <br />TYPE New <br />RepaidMaint. <br />HEATSOURCE <br />ElecVic <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />f%j: i'I , j fit vc fv�o+� �/! G✓�✓1 ��(/ <br />NO.. I TYPE OF FIXTURE OR ITEM <br />A/C — A/H.INDLING UNITS <br />FORCED Alit SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPIACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />N o r�-A <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS.TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GR4NTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PEP.FORA4ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPE�TY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />COtdTRACTORS IAW i827 f�1�J AND 296200 WAC. <br />, <br />�of ta "� <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />Iy <br />