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FERMIT APPLlCATIuN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />�% SITE ADDRESS <br />LEGA LOi NO. BLOCK <br />DESC. <br />OWNER — <br />TRACT <br />PARCEL TAX I.D. # <br />PERMIT p <br />�u�,���.� Sc.��v�- G'LL3 T P�� �. G/S��J i 35S1: U. <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />CONTRACTOR <br />PHONE <br />PROPOSED USE OF BUILOING <br />CONTRACT PRICE OF WORK <br />WORN DESCRIPTION <br />NO. � TYPE OF FIXTURE OR ITEM <br />' � WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATOR� (WASH BASIN) <br />I SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />� _ CLOTHES WASHER <br />� URINAL <br />�, DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PP,EVENTER <br />� SINK (SERVICE;�AR/MOP/ETC.) <br />� OTHER <br />ADDRESS <br />Building Mochanical <br />PERMIT � Combination R Piumbing <br />TYPE Demolition � Sign <br />Sprinkl�r <br />ZIP CONTR. LICENSE p <br />Addilion HEATSOURCE <br />WORH PJleration EleIXric <br />TYPE Naw Gas <br />Repair/Maint. Other <br />CITY OF EVERETT LOCAL SALES 7AX (.ODE IS 3105 <br />NO. � TYpE OF FIXTURE OR ITEM <br />N/G — A/HANULING 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 />I HEREBY CERITIFY THAT I HAVE READ PND EkAMINED THIS APPLICATION AND KNOW THE SAME TO BE iRUE AND CORRECT. ALL <br />PROVISIONS OF IAWS A�ID ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIEU HEREIN OR <br />NOT. THE GRANTING OF A PER611T DOES N07 PRESUME TO GIVE AUTHORITV TO VIOLATE CR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW RCGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPER7Y TO PERFORM THE Ih'ORK FOR WHICH APPLICATION IS MADE AND I CCMPLV'NITH THE STATE <br />� CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />� <br />� ;-� -� a.���,� . q- 3 �3 <br />� Signaturo o( OwneNContraclor/AuthonTed Ane�� n.,�e <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />