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�I'ERMIT APPLICATION <br />CITY OF EVERETT PEaMIT SER'JIGES <br />3200 CEDAR STREET, EVERE'TT, �NA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE AD/DRESS <br />� C{ C:� �� ��r w) <br />1 <br />LEGAL LOT NO. BLOCK <br />DESC. <br />OWNER <br />TENANT NAIAE <br />PHONE � ' � " � <br />��c�„>�c_ ,-/^t <br />PROPOSED USE OF BUILDING �'� <br />PERMIT <br />TYPE <br />CONTR4CT PRICE OF WORK <br />WORK DESCRIPTION <br />NO. I TYFE 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 />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />PARCEL TAX I.D. # <br />TRACT <br />ICONTAGT FOR PERMIT <br />A�DRESS <br />�Building n Mechanical <br />Combinalion ( 5 Plumbing <br />Demolition � Sign <br />Sprinkler <br />PERMIT # <br />PHONE <br />ZIP CONTR. LICENSE # <br />Addition HEATSOURCE <br />WORK Alteration R Electric <br />TYPE New �{ Gas <br />RepaidMaint. L� Other <br />CITY OF EVERETT LOCAL SALES �iAX CODE iS 3105 <br />NO.. I TYPE OF FIXTURE OR ITEM <br />A/C — AIHANDLING UNITS <br />FORrED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER_ <br />I HEREBY CER:TIFY THAT I HFVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIOINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH'JJHETHER SPECIFIED 11EREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES N07 PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCGL THE PROVISIOR OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE VJORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />DEBIT R CREDIT CARDS ARE NOT ACCEPTED <br />