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�� <br />SITE ADDRES <br />t i �^ � �� � � <br />LEGA LOT NO. <br />DESC. � .� 'Z <br />PE�iMIT APPLICATIG�� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />BLOCK <br />UU I O-OZ <br />l-v I � <br />PAFiCEL TAX I.O. # <br />c�ou�sg o�l <br />TRACT <br />Uloo3 W Vi � <br />cor oZ <br />`�4,Zo� <br />P,�RIAIT a <br />t�� 3c.a -o/ <br />// <br />T�"ANTNAME - CONTACTNAME PHONE I <br />(���,�a-� /Y�o-%� I �u.��.�v,J I <br />CONTRACTOR -�����C_VZ AD�RESS ZIP CONTR. UCENSE M I <br />PHONE <br />PROPOSED USE OF BUILDING <br />CONTRACT PflICE OF WORK <br />WORK DESCRIPTION <br />(_Y1 e nC.� c; <br />Building Mechanical <br />PERMIT R Combination R Plumbing <br />TYPE D Demolilion p Sign <br />U Sprinklcr <br />f�C�c� I�tit <br />'�� x �a <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ WATEfl CLOSET <br />_ 6ATHTUB <br />_ �AVATOFY (WASH BASIN) <br />_ SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DFINKING FOUN7AIN <br />FLOOA DRAIN <br />BACKFLOW PFEVENTER <br />_ SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />Addition <br />Alteration <br />New <br />Repairildaint. <br />HEATSOURCE <br />�Electric <br />Gas <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />NO. � TYPF OF FIXTURE OR ITEM <br />A/G - A/HANDLING UNITS <br />FORCED AIR SYST[MS <br />HEATPUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />AANGEHOOD <br />WATER HEATER <br />METAL FIREPLACEiSTOVE <br />FIREPLACE iNSERT <br />GAS FIREPLACE <br />GAS FiANGE <br />GAS PIPING <br />EXHAUST FAtJ <br />OTHER <br />I HEFEBY CEPITIFY THAT I HAVE READ AND EXA�dINED THIS APPLICATION AND KNOW THE SAME TO 8E TAUE AND CORRECT. ALL <br />PROVISIONS OF LAWS ANO ORIDINACES GOVERNING THIS IYPE OF WORK WILL BE COMPIIED WITH WHEiHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PEPMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF nNY OTHER <br />STA7E OR LOCAL LAIN FEGULATING CGNSTRUCTION OR THE PEPFORMANCE OF CONSTRUCTION. 7HAT I Ald AUTHORIZED BY THE <br />OWNER OF THIS PROFERTY TO PERFOFM THE WORK FOR WHICH APPLICATION IS 1.1ADE 0.ND I COMPLY WITH THE STATE <br />CONTAACTORS LAW 18.D fiCW AND 296200 WAC. <br />t� <br />