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�PERMIT.APPLICA� ION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, ';VA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />1�30 �UevC�2��4.wWW�� �oc <br />=GA LOTNO. BIOCK TRACT <br />NAME <br />PARCEL TAX I.D. # <br />CONTACT FOR PERMIT <br />�?UUdi1'Cc�ic /7'��Y"v � / <br />CONTRACTOR DVn k� �� �' y�.t1E G F� A'W � �� ADDRESS � c� ZTO>c Tv R <br />izr� � w-c � w o-y �- �- <br />PHONE <br />PROPOSED USE OP BUILDING <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />�lTkr�v��(a,� <br />� w Si /'4n,Bvc <br />N0. I TYPE OF FIXTURE OR ITEM <br />� <br />Building rw-� Mechanical <br />PERMIT R Combination�j F'lurtlbl�g <br />TYPE g Demolition U Siyn <br />Sprinkler <br />d� �o�v��vcr�� <br />WATER CLOSET (TOILET) <br />BAiHTUB <br />LAVr+TORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <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 />OTHER <br />c6-F�; <br />PERMIT # <br />o I Xo3c� 5- <br />PHONE <br />ZIP CONTR. LICENSE # <br />y^PO Z Z <br />�Addltian <br />Alleratlon <br />New <br />Repair/Maint. <br />HEATSOURCE <br />�j Electric <br />B Gas <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />r� w v� u.T 5p �-�. <br />NO.. I TYPE OF FIXTURE OR ITEM <br />A/C—A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES URYER <br />RANGE HOOD �/ln� <br />WATER HEATER 7/eJ` <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS R,4NGE <br />GAS PIPING I . <br />EXHAUSTFAN '�1 <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING TtIIS TYPE QF WORK WILL BE COMPLIEO WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORih' TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE P�RFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW A�D 296.200 WAC. <br />� /,,��i s//d /n ? <br />DEBIT 8� CREDIT CARDS ARE NOT ACCEPTED <br />