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� PERMIT APPLICATION <br />CiTY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />sire aooRess <br />�0.� �.Q/l tiCU ti ��00 <br />LEGAL LOT NO. BLOCK <br />DESC. <br />oWN� �, �. g � <br />/ <br />`P� Q:7/ <br />TENANTNAME I <br />�0-�� �a�2 _J-W�G�< D <br />CONTRACTOR <br />PHONE <br />,..�P il R �— <br />PROPOSED USE OF BUILOING <br />/T�""�-- ��`"'� <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />PARCEL TAX I.D. # <br />TRACT <br />�x9o� �0{ CG'�i <br />CONTACT FOR PERMIT <br />ADDRESS <br />Bui�ding Mechanical <br />PERMi7 � Combination R Plumbing <br />TYPE Demolition D Sign <br />Sprinkler <br />NO. � TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />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 />�ISINK (SERVICE/BAR/MOPIETC.) <br />OTHER <br />/- 0/v <br />PHONE <br />Zli' GUN 1 K. LIGCI'1oC M <br />Additlon <br />WORK Alt=ratlon <br />TYPE New <br />RepalrlMaint. <br />HEA750uKce <br />�Eiectric <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />NO. .I T'�PE �F FIXTURE OR ITEM <br />AIC — AIHANDLING 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 />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERITIF( THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINF.CES 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 OR CANCEL THE PROVISION OF ANY OTHGR <br />STATE OR LOCAL IAW REGULATING CONSTRU(:TION OR TNE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />Signature of Owner/Contractor/Authorized Agent Date <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />