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P�RMIT APPLICATI� <br />CITY OF EVERETT PERMIT SERVICES <br />ET EVERETT WA 98201 <br />3200 CEDAR STRE <br />425-257-8810 - FAX 425-257-8857 /�,� n�ti/ J1 �� <br />l 'J7J`)�lf=7 -G/�J <br />SITE ADDRESS <br />LEGA LOT NO. <br />DESC. <br />OWNER <br />TENANTNAME <br />CONTRACTOR 5���*�L�M�(N6 <br />/�r�cH�iN/< <br />PHONE a�� 7 �� _ �S� <br />PROPOSED USE OF BUILDING <br />PARCEL TAX I.D. # <br />TRACT <br />CONTACT FOR PERMIT <br />ADDRESS I��2 I�� �V� S I Z�P <br />SQot� , t�.bi �I`b �`{'� + <br />Building D Mechanical <br />PERMIT R Combinalion U Plumbing <br />TYPE Demolitian U Sign <br />Sprinkler <br />CONTRACT PRICE OF WORK� � � i�Q <br />// <br />WORK DESCRIPTION �r_ <br />✓�i� <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />.� �a'o�� <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DR41N <br />BACKFLOW PREVENTER <br />SINK (SERVICEIBAR/MOP/ETC.) <br />OTHER <br /># <br />PHONE <br />CONTR. LICENSE # <br />s �A�pN, � 4�t4 <br />Addition <br />Alleration <br />New <br />Repair/Mainl. <br />HEATSOURCE <br />Electric <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RNNGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <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 U1WS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL C7E COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION 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 WORK FOR WHICH APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br />CONSRACTORS lAW 1827 RCW AND 296200 WAC. <br />��7 <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />