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PE�tMIT APPLICATIO�v <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-P810 - FAX 425-257-8857 <br />�/ � .� �'-r'� tn� <br />—o-- <br />SITE ADDRESS ^ �l �(�i PAFiCEL TAX I.O. ti � I PERMIT x <br />DESC. <br />LOT N0. <br />NAME <br />�ccl�2. C�2r� (� <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />TRACT <br />CONTACTNAME <br />ADDRESS <br />So� � ST/JG� C'.�.�m <br />�] 6uilding Mechanicai <br />PERMIT L) Combination� Plumhing WO <br />TYPE D Demalition Sign 7Y1 <br />U Sprinkier <br />WORKDESCRIPTION ����/ C��� <br />S✓�j�l�� �` (I.e�i/in, �,�icc�-� <br />�!'G. Gj�uCTTvcc�iF— . <br />N0. I TYPE OF flXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATOFiY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DflAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOPIETC.) <br />OTHER <br />c�r rnv�vc �ry_� <br />/7 � �CA� <br />' �- `"I U' �f' 312�� /57S <br />PHONE <br />ZIP CONTR. LICENSE R <br />`�d'cz�i EiYlE�zos'9� <br />Addition I HEATSOURCE <br />K Alteration Electric <br />. New �Gas <br />Repair/Maint. Othar <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />��rJ✓�C�D� i%i1r� �D✓�CCe �1f! e� Inler(Ur'(�(C%iti <br />v- i�Shrll �1e. C?xhcu.�Sf �� v-�/� oi�¢-r <br />N0. I TYPE OF FIXTURE OR ITEM <br />L A/C—A/HANDLINGUNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAI FIREPLACE/STOVE <br />_ FIREPLACE INSERT <br />GAS FIREPLACE <br />G`AS RANGE <br />�_ GAS PIPING <br />�_ EXHAUST FAN <br />OTHER <br />�� 1 HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND COF;RECT. ALL <br />PROVISIONS OF LAWS AND OFIDINACES GOVERNING THiS TYPE OF WOAK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />� NOT, THE GRANT�NG OF A PEFMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEI THE PROVISION OF ANY OTHER <br />�� STATE OR LOCAL IAW REGULATING CONSTRUCTION OR THE PEi;FOFMANCE OF CONSTiiUCTION. THAT I AM AUTHORIZED BY THE <br />� OWNE OF THIS P�ERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH l'HE STATE <br />� C0� CTORS LA� RCW ANO .200 WAC. <br />� ��6� <br />S n ure of 0 ner/ iractodAulhon gent DAte <br />� � �� <br />