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SITE ADDRESS <br />LOT N0. <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT �ERVICES <br />3200 CEDAR STREET, EVERETT, V�'A 98201 <br />425-257-8810 — FAX 425-257-b857 <br />TRACT <br />PARCEL TAX I.D. # <br />PERh41T d <br />� <br />uuness ZIP PHON <br />�hson �j�/-�i�5 � ves-rm2hfs, L�.G 98'-2a� 4-� 3S"3 8446 <br />`r�6Fl��vn���.�v ��'��.y`��' <br />TENANTNAME I CONTACTNAME pHONE <br />Thro R�s�cw�i-�art� -�c, <br />— � � � Ma,c�N 4.� r — �-/ � — 9SS�- <br />CON7RACTOR ADDRESS ZIP CONTR. LICENSE p <br />PHONE � /1�� ti� <br />l j. <br />PROPOSEO USE OF BUILDING <br />i <br />CONTRAC; P ICE F WORK <br />WORK DESCRIPTION <br />��-� <br />PERMIT � <br />TYPE <br />/`�✓ V "� �� <br />NO. � TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <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 (SERVICFJBAR/MOP/ETC.) <br />OTHER <br />Building Mechanical Addition HEATSOURCE <br />Combination Plumbing woRK RL..[ Alieration �1F�.Xc Electric <br />DPmolition Sign 7YPE (,,.] NeP " j�'Ges <br />S rinkler U He atdMaint. L� Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />.�a-�-�.�c._e �J �a,.�,e2 ��/� S <br />// <br />NO. � TYPE OF FlJCTURE OR REM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INS[RT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORqECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERN�NG THIS TYPE OF WORK WILL BE COIAPLIED WITH WHEfHER 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 LOCAI LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT t AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />SignaWre of Owner/ContractodAuthonzed Agent Date <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />�L <br />