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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES /'Yn <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />6 —1 <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />�� <br />/J C=� Gt%% <br />M0� lP'"mil <br />LEGAL LOT NO. <br />BLO K <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />A/NT NAM/E /,� <br />CONTFA j �FORERIT PHONE <br />K I��_ <br />CONTRACTOR / ADDRESS /77�ZIP CONTR. LICENSE # <br />� <br />lti�Li3G/� <br />PHONE//,ZS� <br />PROPOSED USE OF BUILDING <br />Building al <br />AditJon <br />OURCE <br />HEARSEecctric <br />PERMIT <br />TYPE <br />{R-( Combination Plumbing <br />L-j Demolition Sign <br />WORK <br />TYPE <br />IR( Alteration <br />New <br />u Gas <br />Lj Sprinkler <br />u Repair/Maint. <br />LJ Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />/�Fryr✓�,�,'o�lG;n.es � (�2 �� <br />,!'-nS�Jl ��fitycr�+�'�G�'S-es�rvN <br />l roc lY� 04, 4S <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />A/C—A/HANDLING UNITS <br />_ <br />BATHTUB <br />_ _ <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK &DISPOSAL <br />CLOTHES DRYER <br />DISHWASHER <br />_RANGE <br />HOOD <br />—_ <br />LAUNDRY TRAY <br />WATER HEATER <br />(P/); <br />_ <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACE(STOVE / <br />FIREPLACE INSERT <br />_ <br />URINAL <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />% <br />EXHAUST FAN <br />OTHER />;;Ie1's <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 THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE GR CANCEL THE PROVISION OF .ANY OTHER <br />STATE OR LOCAL LAW REGULAT NG .ONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROP TY T E ORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTR T�S LAB"r 6MjW R A 296.200 WAC. <br />Sigha) oFOwher/ ontract /Authorized Agent Date <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />