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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />qo4 �, a <br />LEGA LOTNO. BLOCK <br />DESC. Z � �r�- ,r <br />OWNER <br />�If1ME S PFLVEfn6.(L -j-w <br />TENANTNAME <br />CONTqACTOR <br />PHON�� <br />PARCEL TAX I.D. 8 <br />TRACT <br />CONTACTNAME <br />�1usr�N ffi� <br />ADDRESS <br />s�-A <br />PROPOSED USE OF BQUILDING <br />Ocu�pa��K D <br />CONTRACT PRICE OP WORK <br />WORK UESCRIPTION <br />Building Mechanical <br />PERMR Combination R Plumbing <br />TYPE Demolition p Sign <br />Sprinkier (x of heads) <br />��/ /�/ •• <br />#� <br />PERMR k <br />ID p.� i <br />20le • <br />PHONE <br />LP CONTR. LICENSE Y <br />Addition MEATSOURCE <br />Alteration [�� lectric <br />New �9"Gas <br />RepaidMaint. L� Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />T��r IMPn.oden�vr — ��o��no� , Bu�«o.��- aF New o�►�s . <br />NO. I TYpE OF FIXTURE OR REM <br />__ WATER CLOSET (TOILET) <br />_ BATHTUB <br />_ LAVATORY (WASH BASIN) <br />_ SHOWER <br />_ KITCHEN SINK & DISPOSAL <br />_ DISHWASHER <br />_ LAUNDRY TRAY <br />_ CLOTHES WASHER <br />_ URINAL <br />_ DRINKING FOUNTAIN <br />_ FLOOR DRAIN <br />_ BACKFLOW PREVENTER <br />_ SINK (SERVICE/BAR/Iv10!'/ETC.) <br />_ OTHER <br />NO. I TYpE OF FlXTUpE OR REM <br />.v� — wnHIVULIN(i 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 INSERT <br />GAS FIREPLACE <br />GASRANGE <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 CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH VJHETHER 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 TNE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.2Z RCW AND 296.200 WAC. <br />3 <br />'la <br />