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SITE ADDRESS <br />; l'u <br />LEGAL _ LOT NO. <br />DESC.� <br />OWNER <br />TENANTNAME <br />P�RMIT APPLICATIOiV <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />BLOCK I TRACT <br />CONTRACTOR <br />����r-t W�z �tu���t�,�,5 <br />PHONE _ <br />PROPOSED USE OF BUILDING <br />PERMIT <br />TYPE <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR I7EM <br />=L WATER CLOSET (TOILET) <br />BATHTUB <br />� LAVATORY (WASH BASIN) <br />[T. SHOWER <br />1 KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />� LAUNDRY TRAY <br />_L CLOTHES WASHER <br />URINAL <br />�DRINI<ING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />�� SINK (SERVICE/BARlMOP/ETC.) <br />OTHER <br />� F7.�r,- C iy,Kt <br />� �>...____�_,_k� �F , �r„_� <br />PARCEL TAX I.D. # <br />ACT FOR PERMIT <br />�Building n Mechanical <br />Combination r�l Plumbing <br />Demolition � Sign <br />Sprinkler <br />L' <br />�� <br />WORK <br />TYPE <br />l�(`1-Fn?_ —�Z� <br />PERMIT R <br />-O6� <br />PHONE <br />ZIP CONTR. LICENSE � <br />,�JOR'� N�PGOSSr�13 <br />Tor� 9fs ZZ3 <br />) Addition HEATSOURCE <br />) Alterafion �j Electric <br />3 New D Gas <br />RepaidMaint. U other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />M <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — A/HAN�LING UNITS <br />FORCED AIR SYSTEMS <br />HEAI'PUMP <br />UNIT FIEATERS <br />CLCTHES DRYER <br />RANGEHOOD <br />L WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE II�SERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I F'cREBY CERITIFY THAT I HAVE READ AND EXA�1INED THIS APPLICATION AYD KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIOINACES GOVERNING THIS TYPE OF WORI< WILL BE COMPLIED �VITH WHETHER SPEGFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLFlTE OR CANCEL THE PROVISION OF ANY OTHER <br />STFTE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF'HIS PROPERTY TO PERFORfA THE WORf( FOR WHICH APPLICATION IS �dADE AND I COMPLY WITH TH'c STFTE <br />CONTRACTORS LAW 18 7 RCV�,' nND 296.200 WAC. <br />���L�il�<� s �-�o�o� <br />Signature of Ow�er ContractodAuthorized Agent Dale <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />