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—� <br />PERMIT APPLICATI�N <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 />iSl I S r � <br />LEGA LOTNO. <br />Bv�����. � �r <br />CONTRACTOR � / „ � a �� w <br />V`_c <br />PHONE '��� �O I —i,j� I <br />PROPOSED USE OF BUILDING <br />o FF,�� S,n���e <br />CONTRAC7 PRICE OF <br />PARCEL TOJC I.D. # <br />TRACT <br />c y � ro e�.i r�,. <br />CONTACT FOR PERMIT <br />� Co l.�l�-� U(/�1� <br />ADDRESS ,�.� ` <br />10l'�7 3s 1�v• > <br /># <br />-�-s - s� l- I 5-3 1 <br />PHONE <br />L(- 7s`- So 1- ! 5' 3 1 <br />21P C�4TR. LICENSE I <br />C� eV• �89r� �I,�WOF� ��Si-�T/ <br />uilding MechaniCal Addition HEATSOURCE <br />PERM�T �Ombination RL�1 Plumbing WORK �Ileretion I �EIeC,ric <br />7YPE Demolition u Sig� 7YPE ew Gas <br />Sprinkler Repair/Maint. Other <br />�_�� �.�� n�J� � CITY OF EVERETT LOCAL SALES TAX CODE IS �105 <br />WORK DESCRIPTION <br />%'.-� [��l �1"-f� rov� N�c-Q wi <br />N0. � TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITGHEN SINK 8 DISPOSAL <br />DISFIWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DR�NKING FOUNTAIN <br />i FLOOR ORAIN <br />BACKFLOW PREVENTER <br />_ SINK (SERVICE/BAR/MOP/ETCJ <br />OTHER <br />NO. � TYPE OP FIXTURE OR ITEM <br />All: - A/IIANULING 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 />EXHAUST FAN <br />OTHER <br />I HEREBY CERI?IFY THP.T I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PP,OVISION5 OF LAWS AND ORIDI�JACES GOVERNING THIS.TYPE OF WORK WILL BE COMPLIED WITH W4ETNER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GI'JE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL lA6V REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE ANU I COMPLY WITH THE STATE <br />CONT CTOg S LAW 78.27 RCW AND 296.200 WAC. <br />� . i1 �7 L� .r'� _ . �. / / <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />