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S�TE ADDRESS <br />LOT NO. <br />PER.M�T APP�.ICATION <br />CITY OF EVERETf PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />BLOCK I TRACT <br />sT <br />I.D. # PERMIT # <br />00.'> ��f� n� SO� C <br />-I! <br />TENANT NAME I CUNTACT FOR PERM�T �� �G�IIsN6 3_ O Z � Z <br />(�/�v,�f£' (��nnv DAH �/''(� �P�(" �NGFL Y�C�tA .vL-f! �iiG,/.�5 <br />CONTRACTOR AODRESS ZIP CONTR LtCENSE# <br />PROPOSED USE OF BUILDING <br />Building Mechanical <br />vERMiT R Combinalion � Plumbing <br />TYPE D Demolition Sign <br />U SprinWer <br />CONTRACT PRICE OF WORK ��,7 � � on <br />WORK DESCRIPTKIN <br />C�rs,��c�;e �Iwrsr�aL <br />NO. I TYPE OF FlXTURE OR REM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />�RINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICElBARlMOPIETC.) <br />OTHER <br />3�X12� <br />��6����-ys� <br />Addition <br />aterauoo <br />New <br />RepaidMeint <br />HEATSOURCE <br />Eleciric <br />Gas <br />Othe� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />NO. I TYPE OF FU(TURE OR REM <br />A/C - AIHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIRePL10El5TOVE <br />FIREPLACE INSF.RT <br />GAS FIREPLAC� <br />GAS RANGE <br />GAS PIPING <br />EXHAUST Fi�N <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ ��:�JD EXMIINED THIS APPLICATION AN� KNOW THE SAME TO 8E'fRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WIIL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW RcGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERN TO PERFORM iHE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACIORS lAW 1827 RCW AND 296.29PYjAC. <br />DEBIT S CREDIT CARDS ARE NOT ACCEPTED <br />