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SITE ADDRESS <br />I l.J�� Q <br />LOT NO. <br />TENANTNAME <br />CONTRACTOR LArr,�f <br />PHONE . . <br />PERMIT APPLICATI�ON <br />CITY OF EVERETT RERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />PARCEL TAX I.D. A� <br />BLOGK <br />CONTACT FOR PERMIT <br />� c' �,��..�, L. � r �� <br />r�� ���, � ��DRESS <br />� 3�-�l Ric��wa7 <br />�m� ^T- <br />PROPOSED USE OF BUILUING <br />�.-� �\ <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION �,�, f ' e � <br />ep�a� <br />L: 4�e � � L� �r�c <br />NO. I TYpE OF FIXTURE OR ITEM <br />_ WATER CLOSET (TOILET) <br />BATHTUB <br />_ LAVATORY (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 />Building hanical <br />PERMIT B Combfnation ?lumbing <br />TYPE D Demolition Sign <br />L� Sprinkler <br />� .la� 1��-p�.""(' <br />��.�p. <br />PERMIT # <br />� <br />FHONE <br />ZIP CONTR. LICENSE # <br />cz�.7o� Lwrr)�11��ctIL� <br />Additlon <br />WORK Alteration <br />TYPE New <br />RepaidMalnt. <br />HEATSOURCE <br />�ecUic <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE !S 9105 <br />w r� r�2 �...., �o -�o` <br />NO.. � TYPE OF FIXTURE CR I'�'EM <br />A/C-A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP � <br />UNIT HEATERS <br />CLOTHES DRYER <br />R4NGE HOOD <br />WATER HEATER <br />METAL FIREPLACEISTOVE <br />FIREPLACE INSER? <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATIC N AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS.TYPE OF INORK WILL BE COMPLIED WITF' WHETHER SPECIFIED HtREIN OR <br />NOT. THE GR4NTING OFl, PERMIT DOES NOT PRESUME TO GIVE AUiH1�RITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW ReGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. 74AT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COM��LY WITH THE STATE <br />CON�Ei,A�TQRS LAW 18.27 RCW AND 296200 WAC. <br />�— <br />QEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />