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P�RMIT APPLICATI�i�i <br />CITY UF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE i1DDRESS <br />' ; Soo �UerGrLcN �-� <br />LEGAL LOT NO. BLOCK <br />DESC. <br />OWNER <br />�GF �nu�s��,�. �� � <br />TENANTNAME <br />ffci %LO :ZO/4 � <br />CONTRACTUR �y�� I��� %�+� <br />, <br />PHONE /I�S ���`�1c� <br />7 <br />PROPOSED USE OF BUILDING <br />PER.'dIT <br />��//O �QN� TYPE <br />CONTRACI' PRICE OF WORK <br />WORK DESCRIPTION A <br />l�ev�o�lt/ ��C,s��.,� bv�l�rH� <br />PLUh1BING <br />NO. I TYPE OF PIXTURE OR IYEM <br />� wni eft cLOSET (TJILET) <br />BATHTUB <br />� LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAI_ <br />� DRINkING FOUNTAIN <br />FLOJF DRAIN <br />�ACKFLOW PREVENTER <br />= SINK (SERVICE/BAR/MOP/ETC.) <br />.� OTHER�,r,tii h i� _ <br />PARCEL TAX I.D. # <br />TRACT <br />CONTACT <br />AUORE55 <br />Building Mechanical <br />Comhination Plumbing <br />Demolition � Sign <br />Sprinkler <br />U.� - <br />;�zs- <br />PHONE <br />ZIP CONTR. LICENSE # <br />�Addilion I HEATSOURCE <br />Alteration Electric <br />New Gas <br />Repair/Mainl. Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />NO. .I TYPE OF FIXTURE OR ITEM <br />/vc: — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UhIT 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 />EXHAUSTFAN <br />OTHER <br />i r+tHter cERITIFY THAT I F!4VE READ AND EXAMINED THIS APpLICATION AND KNOW THE SAM1tE TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND GRIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING 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 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 WITH THE STATE <br />CONTRAC/T/O�S�1 W 18.27 RCN/ AN� 296.200 WAC. <br />� `� �1�T __ / , <br />DEBIT & CREDIT CARnS ARE NOT ACCEPTED <br />