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PtRMIT' APPLICATI(�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAP. ST�2EET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />S�/ / /�-l'� <br />BLOC!. <br />DESC <br />TRPCT <br />PARCEL TAX I.D. A <br />PERMIT p <br />/YI D �o(� -D/ <br />1 / ,/ <br />�L«tJ/ 9rYl�.G�l /L� �G �J YJ� �%/�D %� 7� <br />TENANT NAM� I CONTACT FOR PERMI7 PHONE <br />CONTRACTOR <br />PHONE GUCS� v <br />ADDRESS <br />ZIP CONTR. LICENSE k <br />PROPOSED USE OF P,JILDING Building Mechanical Addition HEAT SOURCE <br />PERMIT R�( Combination �R.�/ Plumbing WORK Alteretlon Electnc <br />�,/�, TYPE �,.j Demolition LJ Sign TYPE New � Gas <br />�� 1✓ t.) Spnnkler Repalr/Malnt. Other <br />CONTRACT FRICE OF WORK (:ITY OF EVERETT LOCAL SALES TAX CODE IS �105 <br />WORK DESCRIPTION <br />�C� /�AC-C. � (-7 ��� <br />NO. I TYPE OF PIXTURE OR ITEM <br />WATER CIOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />!7RINKING FOUNTAIN <br />fLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER_ <br />NO. I TYPE OF FIXTURE OR ITEM <br />WC—P/HANDLING UNITS <br />FORC'=D AIR SYSTE�dS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />R.4WGE HOOD <br />WATER HEATER <br />�d�TAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />� HEREB'�� CERITIFY THAT I HAVE READ AND EXAMINED THIS �PPLICATION AND KNOW THE SAME ?0 BE TF.UE AND CORRECT. ALL <br />�� PROVISiONS OF LAWS AND ORIDINACES GOVERNING THIS TVPE 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 C9NSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTMORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />I CONTRACTORS LAW tg.27 RCW AND 296.200 WAC. <br />I� Signah�re of Owner/Contracror/Authonzed Agunt Date <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />