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/ <br />SITE ADDRESS <br />�� <br />LEGA LOT N0. <br />DESC. <br />OWNER <br />TENANT NAME <br />:�� � �fi� <br />CONTRACTOR � P � <br />C°9// <br />PHONE � <br />�� � � � <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />i-ERMIT APPLICATiJN <br />ClTY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />cv��� <br />r✓ �o� <br />BLOCK <br />� <br />TRACT <br />A�URESS <br />PARCEL TAX I.D. # <br />oy�e <br />d� <br />CI�P <br />Building � D pAechanical <br />PERMIT B Combination � Plumbing <br />TYPE D Demolition Sign <br />U Sprinkler <br />WORK DESCRIPTION <br />�/l ZJ�P"C� <br />N�• I TYPE OF FIXTURE OR ITEM <br />_ WATER CLOSET <br />BATHTUB <br />%i LAVATORY (WASH BASIN) <br />_ SHOWER <br />_ KITCHEN SINK 8 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 9Vi'�( t i / , <br />x <br />+c <br />PHONE <br />y�r 3 ys-� <br />ZIP CONTR. LICENSE # <br />�✓cu�e�/pc <br />���%G 9�s <br />�Addition <br />Alteralion <br />Naw <br />Repair/Maint. <br />NEATSOURCE <br />D Electric <br />B Gas <br />Other <br />CITY OF EV[REfT LOCAL SALES TAX CODE IS 3105 <br />'aU ✓ S'�wl�� �/h"�C� S <br />'1�' .3l�Je l/ S�r�- <br />NO. � TYPE OF FIXTURE OR REM <br />A/C — A�HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIFEPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />J� <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 ORI�INACES GOVERNING THIS 1YPE OF WORK WILL BE COMPLIED WITH WHEfHER SPEC�FIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHOflITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW GULATING CONSTRUCTION OR THE PERFORPAANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PR TY TO PERFORM THE WOAK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS �27 RCW AND 296.200 WAC. <br />/ v � <br />� i <br />�_._ <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />