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P�RMIT APPLICATI <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRESS <br />� 3 c� �v� <br />LEGAL LOT NO. <br />DESC. <br />TENANTNAME <br />�I�CJ � 4 c� l� N bti� <br />CONTRACYOR <br />�1�L-� s,� s�, s�k,� 5 <br />PHONE <br />�o�- � �a-�.3t �-f <br />PROPOSED USE OF BUILDfNG <br />�=;����y <br />CONTRACT PRIi.E OF WORK LJ O <br />WOHK DESCRIPTION <br />�ws�lz..11 3 ti1 e�� <br />NO. I TYPE OF FIXTURE OR ITEM <br />PARCEL TAX I.D. # <br />TRACT <br />CONTACT FOR PERMIT <br />r' l.o..l <br />� ����� � �-% <br />PERMIT m <br />S o3/l -O/o <br />PHONE <br />.�c�-��� -�3ry <br />A�DRESS ZIP CONTR. LICENSE # <br />��oC��v �l fS:� Ic� P` i�� ,`l���g n(ea65 <br />Building Mechanical <br />PERMIT R Combination � Plumbing <br />TYPE D Demolilion Sign <br />u Sprinkler <br />C"f� <br />� (n c�nn� � <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAI_ <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLON PREVENTER <br />SINK (SERVICE/9AR/MOP/ETC.) <br />p?i1ER <br />f Lt IO <br />TYPE <br />n Addition <br />I"'S q��eralion <br />�_� New <br />Ll Repair/Maint. <br />HEATSOURCE <br />D Electric <br />B Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br />l—'�� L..� c� �� S R�vt S <br />u <br />NO. I 1YPE OF FIXTURE OR ITEM <br />A/C—F✓HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMMED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COtv1PLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DUES MOT PRESUtdE TO GIVE AUTHORITY TO VIOLATE 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 PEi2FORM THE WORK r'OR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />� <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />