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_. � _ _ __... --- - __ <br />�_- ---- <br />PE�MIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WP, 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADORESS PARCEL TAX �.D. N <br />� �•_ � ;-. . ,' � %- i��-.� %i ; �: �>,� �5 .S o 0 <br />I IEGAL LOT NO. BLOCN TRACT / ^/�T <br />� OESC �y '. ;%0 D � —(I� �,l f5 % �.(�'cnc� �� <br />II OWNER <br />� i . . � �. . . � <br />! TENANT NAME <br />ii COMTRACTOR �. i i � <br />��'� PHONE � _ <br />� � i j <br />CONTACT FOR PERMIT <br />ADORESS . . . �; � - <br />f <br />-L3 <br />i= a r <br />PHONE <br />ZIV CONTR. LICENSE N <br />f�yL(� j <br />I PROPOSEO USE UF BUILDINO Bwlding Mechamcal CA�tion HEAT SOURCE <br />� PERMIT �-COmbina�ion Plumbmg WORK �Atlmatian � Eleclnc <br />� . - TVPE Demolihon � S�gn 7VPE D New Gas <br />Sprinkler U Repamtla�n� Otner <br />� CONTRACT PRICE OF WORN CITY OF EVERETT LOCAL SALES TA%COUE IS 7106 <br />j WORH DESCRIPTON <br />n,, <br />, � -,- <br />'�, NO. TVPE OF FI%TURE OR ITEM <br />�" ` WATER CLOSET � <br />; BATHTUB <br />;_ LAVAIORY (WASH BASIN) � <br />/ , �� SHOWER <br />KI7f.fiFN SINK 8 DISPOSAL <br />DISHWASNF_R <br />� LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DHINKING FOUNTAIN <br />� FLOOR DRAIN <br />BACKfIOW PREVENTER <br />SINK (SERVICEIBARIMOP/ETC ? <br />__i O1HER <br />NO. I TVPE OF FII(TURE OR ITEM <br />_� A/C - AMANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEATPUMP <br />UNIT HEATERS <br />CLOTHES DRVER <br />RANGEHOOD <br />WATER HEATER <br />IdETAI FIREPLACEISTOVE <br />FIREPIACE INSERT <br />GASFIREPLACE <br />GAS R4NGE <br />GAS f�IPING <br />�,�-� EXHAUST FAN � � � <br />__ OTriER <br />I HEREBV CERITIFV THAT I MAVE READ AND LXAMIHED TMIS APPLICATION AND KNOW TMF SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF lAWS AND ORIDINACES GOVERNING THIS TVPE OF WORII VNLL BE COMPLIED WITH WHETH[R SPECIFIED HER[IN OR <br />� NOT THE GRANTING OF A PERMI7 DOFS NOT PRESUME TO GIVE RUTNORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STA7E OR LOCAI LAW qEi�ULA7ING CUNSiRUCTION OR TME PERFORMANCE OF CONSTRUCTIUN THAT I AM AUTMORIZED BV TME <br />OWNER OF iH15 Y� JPERiV TO PERFORM TME WORh FOR WHICM APPLICATION IS MA�E AN01 COMPIV WIiM THE 5?ATE <br />�'" CONTRACiO�LAN182iRCWAND2%200WAC <br />�r <br />�� - � • � �� � � , �� <br />� ' <br />_' __ '_'____._'_"_' __. J _� <br />S�gnaL. � ol ONnodContradorlAuthonzed Agent Ua�e <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED /Z_ <br />