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S�TE ADDFiESS <br />B � � s [s�zvaf� <br />LEGA LOT N0. <br />DESC. <br />� ERMIT APPLICAT���N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />BLOCK � TRACT <br />PARCEL TAX I.D. N <br />�ic�- MVW�A.� <br />TENANT NAME CONTACT FOR PERMIT PHONE �� <br />EPWI�f'-(=� Jp��S JAiJ�GS T1�101�5, P,�-�tktl�, 7fij_D6�� <br />CONTRACTOP. ��.-. 1 �� , 4 ADDRESS `�, ZIP CONTR. UCENSE A� <br />t7N Yv I���� �+ —/`Y1�j ��VC�+!'(/� <br />PHONE C� ^ � L� � <br />a �� <br />PROPOSED USE OP BUII.DING <br />.�� ��vF-. <br />Building Mechanicai <br />PERMIT R Combination R Piumbing <br />7YPE Demalition � Sign <br />B Sprinkler <br />Addition I HEAT SOUflCE <br />iK Alteretion � Electd�, <br />. Nev� `(- � Gas <br />Repair/Maint. Other <br />CONTRPCT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIRTION <br />r-(4 b � tc�-n�,�Nt �MPf��i' <br />NO. I TYPE OF FIICTURE OR ITEM <br />_ WATER CLOSET <br />6ATHTUB <br />I � LAVATORY (WASH BASIN) <br />_ SHOWEfi <br />_ KITCHEN SINK 8 DISPOSAL <br />DISIiWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />_ SINK (SERVICE�BAR/MOP/ETC.) <br />N0. I TYPE OF FlXTURE OR ITEM <br />�!JC -A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />_ HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />A RANGEHOOD <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 AND EXAMINED THIS APPLICATION AND KNOW THE SAM� TO BE TRUE AND CORREC7. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF 6YORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PEPMIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGUfATING CONSTRUCTION OR THE PERFORMANCE OF CONSTPUCTION. THAT I AM AUTHORI2ED BY THE <br />OWtJER OF THIS PROPERTY TO PERFORM THE WORK FOR 1NHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 7827 RC'JJ AND 296.200 WAC. <br />G�'• ZZ' _ <br />DEBIT & CREDIT CAROS ARE NOT ACGEPTED <br />�L <br />