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SITE ADDRESS � <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />TENANTNAME <br />CONTRACTOR <br />PHONE <br />P�RMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEUAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />`v 3 / �'ce�,;.1.� .4�{ <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />BLOCK <br />TRACT <br />PARCEL TAX I.D. # <br />CONTACT FOR PERMIT <br />A��RE55 <br />Building Mechanical <br />PERMIT � Combination � Plumbing <br />TYPE Demolition Sign <br />Sprink�er <br />WORKDESCRIPTION Ol�'��� �/� p�a...�t <br />Q _. <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLGTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />ZIP <br />PERMIT # <br />PHONE <br />CONTR. LICENSE # <br />n Addition <br />I"S Alteration <br />K NeH� <br />U RepaidMaint. <br />HEATSOURCE <br />�Electric <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SAI_ES TAX CODE IS 3105 <br />� /�Gc�o�� oZ9 <br />N0. <br />TYPE OF FIXTURE OR ITEM <br />A/C - A/HANDLING UNITS <br />FORCED AIR SYS7EMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WAT[R HEATER <br />METAL FIREPLACEISTOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW 7Hc SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF L4WS AND ORIDINACES GOVERNING THIS TYPE OF YVORK WILL BE COMPLIED WITH WHETHER SFECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PcRM1T DOES �IOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOC4L LAW REGULr1TING CONSTRUCTIUN OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PR TY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTOP. W 78.27 R AND 296.200 WAC. <br />S��/vY <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />