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ERMIT APPLICA�ON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDR SS <br />� <br />LEGA LOT NO. BLOCK <br />DESC. <br />OWNER <br />TENANTNAME <br />CONTRACTOR <br />PHONE <br />PROPOSED USE OF BUILDING I <br />PERMIT <br />TYPE <br />CJNTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />PARCEL TAX I.D. X <br />i <br />TRACT <br />ADDRE55 <br />ICONTACT FOR PERMIT <br />ADDRESS <br />RBuilding Mechanical <br />Combination R Plumbing <br />Demolition p Sign <br />Sprinkler <br />CITY OF <br />���.�� 1���2e� <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />9ATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHEP, <br />URINAL <br />ORINKING FOUNTAIN <br />FLOOR DR41N <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BARIMOP/ETC.) <br />QTHER <br />PERMIT # <br />ZIP PHONE <br />PHONE <br />ZIP CONTR. LICENSE p <br />ACditlon NEATSOURCE <br />WORK R PJteraUon � Electric <br />TYPE D New Gas <br />U Repair/Maint. Other <br />�,�0��� �dZ� � <br />,r�i6�-��3 <br />NO. � iVA.g OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEATPUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />R4NGEHOOD <br />WATER HEATER <br />METAL FIREPLACEISTOVE <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND E,YAMIhED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PRCVISIONS OF LAWS AND ORIDINACES GOVERNIf�C+TH15 TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL L.AIN REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION THAT I AM AUTHORIZED 6Y THE <br />OWNER OF THIS PROPERTY TO PeRFORM THE WORK FOR WHICH APPIICATION IS MADE ANO I COMPLY WITH THE STATE <br />CONTRAGTORS LAW 1827 RCW AND 296.200 WAC. <br />Signawre ot Owner/ConhacrodAuthonzed Agent Date <br />DEBIT 8� CREDIT CARDS ARE NOT ACCEPTED <br />