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PERMIT APPLICATIOnI <br />CITY OF EVERFTT PERMIT SEl2VICES <br />3200 CEDAR S f REET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS � G'z-� <br />- r �w� <br />LEGAL� LOT NO. BLOCK <br />�ESC.� � <br />OWNER <br />a��s�a �,�n��� � � - �+�f <br />TENANTNAME <br />. �-� <br />CONTRACTOR <br />PHONE ���-�� '; � � <br />PROPOSED USE OF BUILOING <br />PERMIT <br />rrPe <br />� <br />CONTRACT PRICE OF WORK �OO� <br />WORK �ESCRIPiION <br />PARCEL TAX I.D. # <br />>s3�loc�� <br />Z <br />TRACT <br />AODRESS <br />3f�t� I.I��L,�-rs,�, %luD 6 <br />CONTACT FOR PERMIT <br />DA�E. i�A.��r�- <br />L�1MY �fnx+-v t�lEl.�t�i <br />ADDRESS <br />�Building Mechanical <br />Combination � Plumbing WORI <br />Demolition Sign TYPE <br />Sprinkler <br />�T�M,� �a��sT�r�l(� �4�o.a5t5 <br />s �u `O�f <br />PERMIT # <br />�405-oug- <br />�,L'7 <br />PHONE <br />¢z� - 2sZ- lP�b�}' <br />21P CONTR. LICENSE # <br />RAddition HEAT SOURCE <br />4lteration Elecmc <br />n New Gas <br />D Repair/Maint I 01her <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />PLUMBiNG —j— MECHANICAL <br />NO. � TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOW ER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTFIES WASHER <br />URIN?L <br />DRIP":ING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SEFVICEISAR/MOP/ETC.) <br />OTHER <br />NO. I TYPE OF FI%TURE OR ITEM <br />A/C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATCR HEATER <br />METAL FIREPI.ACE/STOVE <br />FIREPLACE INS[RT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />li I HEREBY CERITIFY THAT I HAVE READ AND EXFMINEO THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />� PROVISIONS OF LAWS AND ORIUINACES GOVERNING THIS TYPE OF WORK 1NILL 9E COMPUED WITH WHETHER SPEGFIED HEREIN OR <br />� NOT. THE GRANTING OF A FERMIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL TNE PROVISION OF ANY OTHER <br />I STATE OR LOCAL LAW REGULATING CUNSTRUCTION OR THE PERFORMANCE OF CUNSTRUCTION. THAT I AM AUTHORIZED BY THE <br />II OWNLR OF THIS PROPERTY TU PERFORM TiiE WORK FOR YlHICH APPLICATION IS AfADE AND I COMPLY WITH THE STATE <br />i CONTRACTORS lAW �827 RCW QND 296200N/AC. <br />� Signat re o wn rlCon� <br />I <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />