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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 />SITE ADDRESS PARCEL TAX I.D. # <br />SJ \ 2���� c�EJ E'c�'R�' I <br />LOT NO. I BLOCK I TRACT <br />l-�a3 <br />i2 aooeEss � ZIp pHONE <br />�rF . t�. a• EJc-c�►� 1ut� Q�m3 �-34i�-�l"lo <br />TENANTNAME -' I CONTACTNAME PHONE <br />CONTRACTOR ����k, ME� ADDRESS ��� 1O �,� Q J �_ bp CONTR. UCENSE � <br />� h <br />PHONE � . 4.� � ' �D�'J4� '�ii` � �.ly � �t,l,� '1�Z23 �b.i1�A 044kN <br />PROPOSED USE OF BUILDING <br />CONTRAC7 PRICE OF WORK <br />WORK DESCRIPTION <br />PERMIT � <br />rrae <br />Building Mechrinical <br />CombineUon R Plumhing <br />Demolition � Sign <br />Sprinkler <br />RAddition I HEAT SOURCE <br />Alleralion �Eleclric <br />BNew Oes <br />Repeir/Maint. Other <br />CITY OF EVERETT LOCAL SALES TAX COUE IS 3105 <br />1U�h�1\ � Nc�� ���-t-t� �1L. ��v«-�u�« <br />NO. � TYPE OF FI%TURE OR �TEM <br />WATER CLOSET <br />BATHTUB <br />_ LAVATOAY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />_ FLOOR DRAIN <br />_ BACKFLOW PREVENTER <br />_ SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />NO. I TYPE OF fl7(TURE OR iTEM <br />A/G—A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />QAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <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 V�WS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PEFMIT DOES NOT P SUME TO GIVE AUTNORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAI L ULATING CONST C ON OR THE PEqFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />CONTRACTOfl L O,R r�N Mlp50HA1�T� RK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />f2 �] <br />� 1�-2.0-0 1 <br />