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SITE ADDRESS <br />�S' $� <br />LEGA LOT NO. <br />TENANTNAME <br />PERMIT APPLICATIO�"N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />�� � Am yk�+1f w�*ji <br />BLOCK TRACT <br />CON7RACTOR <br />�+� Ic�u Kw��<<a���v�� <br />PHONE <br />PROPOSED USE OF 3UiLDING <br />CONTRAC7 PRICE OF WORK <br />WORK DESCRIPTION <br />f�(3d �/'e <br />PARCEL TAX I.D. # <br />ICONTACTFORPERMIT <br />�W` ADDRESS � � ¢�� —�6 y <br />��wn� clr�i9.�2 Z <br />Building D t,Aechanical <br />PERMIT B Combinati0n �j P!Umtling <br />TYPE I] Demolition U Sign <br />U Sprinkler <br />/ a� ztG �' <br />PERMIT # <br />X Gti <br />PHONE <br />21P CONTR. LICENSE # <br />��'LtK�ZL�TOo�rNG <br />Addition I HEATSOURCE <br />Alleralion Electnc <br />New Gas <br />Repair/Maint. Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />(�-.y�suwD IrV�TI"c rL (rlA S T�. <br />N0. I TYPE OF FIXTURE OR ITEM <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 DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />i� � fti l f <br />N0. . I TYPE OF FIXTURE OR ITEM <br />A/G—A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYFR <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 CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OP A PERMIT DOES NOT PRESUME TO GIVE AUTHORITYTO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 8Y THE <br />OWNER OF THIS PROP'tRTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTC OR�W 1827 RCW AND 296.200 WAC. �//�/� � <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />