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pERMIT APPLICATION � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 _' / <br /> �05�-1 - Cib2� <br /> SITE ADURE55 PARCEL TA% I.O.M pERMIT s <br /> 3 Gc�✓i3 0 �f/i � 7r��.SZv o�vv- vis_ <br /> .EG4 IOTNp. BLOCK TRACT <br /> �£5C I <br /> a�N q ADDRESS ZIP HONE <br /> Si� iF�tRS ..713i �ET�� �}r,c 9�.bi y.�s•3s�ao�p/ <br /> tENMtT NANE CONTACT FOR PERMIT PHONE <br /> `�' �j'i �/r�� �/�S' �/`T S /p?.5 �j <br /> CONTRACTOR GH/G%'�JA•N C�r ST ORESS ZIP CONTR.UCENSE t � <br /> C,�/itr� ,f vS�i3y <br /> PHONE i <br /> �f�5 �sNs i..t sf� /3 d y6 �i�s� � .t�' /��r¢v� cu,► 9,l�?y <br /> VROPOSEO USE OF BUtLDINC I ('') BwWmp idechan�cal AtlO,Um NEAT SOURCE I <br /> PERMR ["} �mbinalion � Plumbmg IWORK � AltDratwn I � Ek�r�c <br /> TYPE D DBrtqlRbn Sign TYPE New Gas <br /> �� $ �� Re alrlMalnt Omer <br /> COHTRACT PRiCE OF WORK WTY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> WORK DESCR�TIOH <br /> ��1'�✓✓ dXF T/�! dcr�i'Tr..w TU �'�/Ji9 S%/�ir�J�17�J <br /> LUMBINC) MECMANICAL <br /> NO ' TYPE OF fl%TURE OR�TEM N0. TYPE Of FIXTURE OR ITEM <br /> �� :fATER CLOSET(TOILET) A1C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR 5YSTEMS <br /> f_� iAYA70RY(WASH BA$IN) HEAT PUMP <br /> _i SHOLVER UNITHEATERS <br /> _ !iTCf+EN SINK 8 DISPOSAL CLOTHES DRYER <br /> LiSM.'�ASHER itANGE HOOD <br /> __ LAUNORYTRAY � WATERNEATER � <br /> _ CLOttiES WASHER METAL FIREPLACE/STOVE <br /> _ UR�NAL FIREPLACE INSERT <br /> _ DRiNKtNG FOUNTAIN _ GAS FIREPLACE <br /> ___ fL00R DRAIN GAS RANGE � <br /> I BACKfLOW PREVENTER GAS PIPING <br /> /.-ISINK fSERVICEBARJMOP/ETC.) Z EXHAUST FAN I <br /> OTMER — OTHER <br /> _I � <br /> �•E?E.BY CERITFV TIU i I MAYE FfAD ANO EXP.M W ED TMIS AS'PLICATION ANb KNOW tMF.SAME TO 8E TRUE AND CORRECT. ALL <br /> � '-���S�ONS OF tAWS A,YO GRiD�NACES GOVERNiNG THIS TYPE CF WOiiK WILL BE COMPUED W'iTH WHETHER SPEGFiED HEREiIJ OR <br /> . ' tHE GtWRiNG OF A PERMIT DOES NOT PRESUME TO GIVE AUTHOR!TV TO VIOLATE OR CAIJCEL THE PROV1310N OF ANY OTHER <br /> �.'-?E�iR lOCA1 LAW REGUU7iNG CONSTRUCTION OR THE PERFOR!AANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE I <br /> :.:ER OF Tn�S PROPEATY i O PERFGRM THE WORK FUR YIHICM APPLICATION IS MA�E AND I COMPLV WI7N THE STATE <br /> . .•.'RACpRSUW E21RC1NAlID295200WAC. <br /> yay�3 <br /> � SqnatUfg f/ MfaCfoN utIWfl2edAgent ate <br /> DEBIT 8 CREDIT CARDS ARE NOT AC�EPTED <br />