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rERMIT APPLICAT.JN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98?.01 <br />425-257-8810 - FAX 425-257-8857 <br />_ X�3 0 4—aG� <br />SITE ADDRESS <br />i �( 0 Z .5 � <ve���; <br />LEGA LOT NO. BLOCK <br />TENANT <br />PARCEL TAX I.D. # <br />30�,�_� 17 Z- <br />CON7ACT FOR PERMIT <br />1 l,r �<���U <br />PERMIT a <br />PHONE <br />s3 ass � �z� <br />CONTRACTOR�/�K� /_',�C � fCsS T�DDRESS 3 � S, �.r � C�p ` CONTR.LICENSGM <br />,CJ J � � 9�/� 4 �°� d��3�� Piur��f� 9 <br />PHONE as'2 ��O /�O � T <br />J � J <br />PROPOSED USE OF BUIL�ING [3uilding fl Mechanical I Addition HEAT SOURCE <br />PERh71T R Combinalion ��Plumbinc WORK �nueration � Fiectric <br />TYPE D Demolition LJ Sign 7YPE New Ges <br />L� Sprinkler fiepair/Mainl. Other <br />CONTRACT PRICE OF WORK <br />WORK �ESCRlPTION (� <br />��h�n�t'nC� 3�d{ �c5��oo�"L <br />✓ <br />N0. I TYFE OF FIXTURE OR ITEM <br />� WATER CL.OSEi <br />BATHTUB <br />� LAVATORY (WASH BASIN) <br />SHOWER <br />KI'fCHEN SINK & DISPOSAL <br />DISHWASHER <br />!AUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />� FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />CITY OF EVERETT LOCAL SALES TAX COD� IS 3f05 <br />��0. I TYPE OF FIXTURE OR ITEM <br />A/C-A/HANDLING UNITS <br />FORCED AIR S�STEMS <br />HEATPUMP <br />UNIT HEATERS <br />CLOTHES �RYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />I HFREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAA1E TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINO.CES GOVERNING THIS IYPE OF WOflK WILL BE COMPLIED WITH VJHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUA1E TO GIVE AUTHORITV TO VIOWTE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OF THE PERFORP.tANCE OF CONSTRUCTION. THAT I Ah7 AUTHORIZED BY THE <br />OWNER OF THIS PROPERN TO PERFOF�M THE WORK FOR WHICH APPLICATION IS MADE AND I COtdPLY WITH THE STATE <br />CONT9AGT�Fi,9'LAW 7Q27 RCIqVAND 2PG.200 WAC. <br />��_�� �.03 <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />