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PERMIT APPLICATiON <br />CITY OF EVERETT PERMIT S�RVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />� <br />LEGA LOT NO. <br />DESC. <br />OWNER <br />% ,P. C2A�� <br />TENANTNAME <br />��Zr� <br />CONTRACTOR ..� <br />�%Cw.�l.� C�NS�• <br />PHONE 3`D G„5�,� Z,� G y <br />PROPOSED USE OF BUILDING <br />� ./.�'�L.K �7 ( <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />� �� ` � ' -� �� <br />�� <br />BLOCK <br />PLUMBIN <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DIS?OSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />I /�.�96 2# ��yy6��38��p1 ,fERMIT� <br />� �J �/� I - �l� <br />TRACT <br />ADDRESS / 21P PHONE <br />�� l'f� /pC� I ��D/ `/z s--.� vq <br />�CONTACT FOR PERMIT% PHONE <br />�% i�����- N.��- .3�0 �:sj�� �y <br />ADDRESS <br />//9�/ �Y%�rT7 if/.G=. L/I' r�P✓!✓3, <br />Building Mechanical <br />PERMIT Combination Plumbing <br />TYPE Demolition Sign <br />Sprinkler <br />, ),'-I. �1 �,.. ,, , � r <br />� , <br />�- <br />TYPE <br />ZIP CONTR. LICENSE A <br />iY�,.:rtc *aoyoP <br />var6o/ 6iz izS <br />n AOtlilion <br />I-"� Alteration <br />fr�r New <br />V Repair/Maint. <br />HEATSOURCE <br />ElecVic <br />Gas <br />Other <br />CITY OF EVERFTT LOCAL SALES TAX CODE IS 3105 <br />NO. I n'PE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METALfIREPLACElSTOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXA1.11NED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTNORITY TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFOR�d THE WORK FOR WHICH APPLICATION IS IdADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />:� <br />, i .� <br />�,'r'o � ,_ U �� <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />I/Z <br />