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PERMIT APPLICATIOnI <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRESS <br />��Ci �, s 'rK'i'1 <br />IEGA LOT NO. � <br />DESC. <br />OWNER <br />����� �. <br />TENANTNAME . <br />CONTRACTOR <br />PHONE � ��E <br />� � SY'�c <br />()— -1� � <br />PROPOSED USE GF BUILDING <br />i 1����.^� l <br />PARCEL TAX I.D. # PERM1IIT t <br />� �o�ov �� �i � / C'��03-� 5 <br />TRACT <br />CONTACT FOR PER1M'IT <br />l.._� ��-- \ "' � ��6 �(� <br />ADDRESS <br />pG l'�ox I� �" <br />��i�nryl �a �'QV1C.� <br />PERMIT <br />rrPe <br />RBuilding n Mechanical <br />Combination y� Plumbing <br />D Demolition � Sign <br />� ) Sprinkler <br />CONTRACT PRICE OF WORK t� C/�1 UD <br />_ J�i <br />WORK �ESCRIPTION <br />� ��� � � <br />C + ���'1/ <br />NO. I TYPE OF �IXTURE OR ITEM <br />WATER CLOSFT (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHtN 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 />OT ER <br />•, I _����C�1 <br />-�) � C> i ���C <br />t'� 1 . <br />Sa�,� <br />PHONE <br />C�as ;5°��33U <br />ZIP CONTit. LICLNSE # � <br />IYPE <br />�Addition <br />Alleration <br />New <br />RepaidMaint. <br />HEATSOURCE <br />Electric <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CO�E lS 3105 <br />c��cc��-Io�� e � <br />�. <br />NO. I Tl'PE OF FIXTURE OR ITEM <br />A/C — AJHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEAT[RS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />� GAS PIP!NG <br />EXHAUSTFAN <br />OTHER <br />� <br />i HEREBY CERITIFY THAT i�4VF READ AND EXAMINEU THIS APPLIC.�TION AND KNO'N THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORI( WILL BE C061PLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUl HORIN TO VIOLATE OR CANCEL THE PROVISION OP ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFOR7AANCE OF CONSTRUCTION. THAT I AA1 AUTHORiZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORId THE WORK FOR WHICFI APPLICATION IS :�fADE AND I COMPLY 4VITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SignaWre of Owner/Con'ractodAuthorized Agent Date ,/� <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />