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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 982017711 /j��1D3� <br />425-257-8810 - FAX 425-257-8857 � T <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # <br />3 I <br />LEGA NO. BLOCK TRACT <br />DESC. z <br />OWNER ADDRESS <br />ADDRESS ZIP PHONE yzS <br />TENANTNAME CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE <br />PHONE <br />PROPOSED USE OF BUILDING Building Mechanical Ad"'a HEAT SOURCE <br />PERMIT Combination Plumbing WORK Alteration Electnc <br />TYPE Demolition Sign TYPE New Gas <br />Sprinkler Repair/Maint. Other <br />CONTRACT PRICE OF WORK /•7Li /7� — CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION,, -r rw �! !G,{y-/� / [ <br />i �yj� <br />,�tyH£S <br />z_ z 7G5 <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 />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR CRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE'BAR/MCP.rETC.) <br />OTHER <br />NO. I. TYPE OF FIXTURE OR ITEM <br />A/C - AIHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE+STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />-EREEY :B.'a <br />1- _'- --- NAVE READ .AND F_XAMINED -HIS APoLIC: 71ON AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PaCVISIC,NS JF _AWS :.NC ORIDINACES GOVERNING'HS' PE OF'NORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NCT. -i-= 3RANTING CF , ?ERMIT ICES'JOT?RESUME -C GIVE AUTHORITY -0 VIOLA, E OR CANCEL -HE PROVISION OF ANY OTHER <br />STATE :R LOCAL _AW REGU:.ATING OCNSTRUCTICN OR'HE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />:'NNE..=.:F -H!S==CPER7" -0 ==RFCRIA -HE'.VCRK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />JCNTRACTCRS LAW "E= RC1V AND=9'6�1.00'.VAC. <br />Signaizzl .VnenCantrac:on utnonze0 gent Dace /Z <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />