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�r ERMIT APPLICA'`�iON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SI?E ADDRESS <br />GJ <br />LOT NO. <br />TENANTNAME <br />PARCEL TAX I.D. # <br />TRACT <br />CONTACT FOR PERMIT <br />MC�305 •o! � <br />PERMIT # <br />PHONE <br />l�N- I' 1 r�� !J (-,Z� I <br />CONTRAC70R ��,�'�� � ADDRESS I(''{�y(. '/�f ZIP CONTR. UCENSE M <br />� � - ' - ` F-1,l.l..� � <br />PHONE <br />PROAOSEO USE OF BUILDING <br />�''t�pu�-•'�' ��'D`-=`-� <br />CONTRACT PRICE OF WORK <br />�1' �yV <br />Building <br />PERMIT B Combination <br />TYPE g Demolition <br />Sprinkler <br />1lUlv <br />�Mechanicai <br />Plumbing <br />L> Sign <br />�G}�czi ,,-0 1 <br />�Addition HEAT SOURCE <br />Alteration � Electric <br />New Gas <br />ReoaidMaint. Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION Lr� .. 1 <br />l��a�� �,a��-�. ca-t�s�� c;�k-���'�� � p�ya 4 v��,a�i.z -,.�,� �,+�. <br />NO. I TYPE OF FIXTURE OR REM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BAS�N) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNT�IN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />NO. I TYPE OF FIXTURE Ofl ITEM <br />A/C - A/HANDLING UNITS <br />FORCED AIF SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGe HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN � M� �(� � �=^�c^�: <br />OTHER t�`O <br />A �i-�'r:� RI�.zC�i�.� <br />h.; x+�� � i�� Z��-. �- t-ic�� j'�.1 <br />—�/�665 6� `--` �4--tG'�=- l`�'�-1de�J. <br />a <br />1 HEREBI' 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 WIT�i WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PEf1M11 )OES NOT PRESUME TO GIVE AUTHOFlITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOC�EGUTATING CONSTRUCTION OR THE PERFORM.INCE OF CONSTRUCTIJN. THAT I AM AUTHORIZED BY THE <br />OWNER OF THf PROP RTY TO PERFORM THE WORK POR WHICH APPLICATION IS MADE AND I CO�v1PLY WIl'H THE STATE <br />CONTRAF;TORS LAW 1B27 RCW AND 296.200 WAC. <br />DEBIT & CREDIT CARDS P.RE NOT ACCEPTED \ 1/L <br />