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PtRMIT ARPLICATI(�N <br />CITY OF EVERETT PERMIT SERVIGES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 ��� � <br />SITE ADDRESS <br />LOT NO. BLOCK � I TRACT <br />DESC. <br />PARCEL TAX I.D. # <br />PERMIT � <br />QJ] <br />yz5- 3Y9- <br />l�ie �- � / ,j� O !`e u2 L°,lD <br />TENANTN ME CONTACTFORPERMIT PHONE <br />�wc: �t � r„J �,u �/�. �4 l�.C., ✓� ,,� � y yzS- 3s/�- a�7'Y� <br />CONTRACTOR / . �D SS MD � � �� Z�P CONTR. LICENSE p <br />f.JO/�. ID�a-Mt�t�.y 129xy %� S�.o�i� � Wb�F�'/OZ033C� <br />PHONE S��'0'�ft( y���O <br />��o - Sr� �.- 9� S 3 <br />PROPOSED USE OF BUIL�ING <br />PERMIT � } <br />TYPE D <br />U <br />CONTRACT PRICE OF WORK 7�j�..n GtJ <br />WORK DESCRIPTION <br />���M s�;�g <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNURY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />Building Mechanical <br />Combination �Plumbing <br />Demolilion Sign <br />Sprinkler <br />NO. <br />Addition HEATSOURCE <br />WORK �Alteretion (� ElecVic <br />TYPE New D Gas <br />Repair/M1Saint. U Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3'105 <br />M <br />TYPE OF FIXTURE OR ITEM <br />A/C — AlHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNI"f HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <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 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 GRANTING OF A PERMIT DOES NOT PRESIJME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITN THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />,- _�_/ � � � �� � - 2Y-o 3 <br />DEBIT & CREDIT CAR�S ARE NOT ACCEPTED <br />