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SITE ADDRESS <br />i7i_ <br />LOT NO. <br />�wERMIT APPLICAT�ON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 % <br />� C uc�rc`�� <br />� a�ooK <br />TRACT <br />PARCEL TAX 1.7. N <br />PERMIT # <br />>'Co3oS-c3r <br />i11 el5cr� 7nvr5-�v,�cv��s <br />7ENANT NAME I CONTACT FOR PERM�T PHONE <br />CONTRACTOR <br />PHONE c / � I � � <br />L-� j <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPiION <br />NO. � TYPE OF FI%TURE OR ITEM <br />_L WATER CLOSET (TOILET) <br />BATHTUB <br />� LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOPIETC.) <br />OTHER <br />PERMIT <br />TYPE <br />ADDRESS <br />� <br />� <br />� <br />� <br />� � y �/ � �-�l 5 <br />Building Mechanical <br />Combinalion ��Plumbing <br />Demoli!ion Sign <br />Sprinkler <br />Z�P CONTR. LICENSE tl <br />Addilion <br />fUleratlon <br />New <br />Repair/Maint. <br />HEATSOURCE <br />ElecUic <br />Gas <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />NO. I TYPE OF FI%TURE OR ITEM <br />_ A!G-A/HANDLINGUNITS <br />_ FGRCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />Z WATER HEATER <br />METAL FIREPLACEISTOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />_ OTHER <br />1 HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE :�AME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINAC[5 GOVERNING THIS TYPE OF WORK WILL BE COMPLIED `NITH Wl1E7HER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORtTY TO VIOLATF CH l'ANCEI THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TFiE PERFORAWNCE OF CONSTRUCTION. TMAT I AM AUTHORIZED BY ThIE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPIY WITH THE STATE <br />CONTR\CTORS LAW 18.27 RCW AND 296.200 WAC. <br />Signature of OwnerlContracror/Authorized Agent Date <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />