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P`�RMIT APPLICATI(�`�� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />1'V1 � i,U_5 —O ol.]. <br />SITE ADDRESS PAHCEL TAX I.D. # � PERMIT q <br />�,d L����,-� ,� ✓ I I ��-3 <br />LOT NO. � BLOCK � TRACT <br />DESC. I <br />OWNER <br />TENANT NAh1E <br />CONTRACiOR ����5 �� <br />I PHONE <br />PRUPOSED USE OF BUIIDING <br />I <br />CONTFACT PRICE OF WORK s��. <br />WORKDESCRIPTION �us,��`[,�NS, <br />NO. I TYPE OF FIX7"URE OR REM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />D�SHVJASHER <br />LAUNDFY TRAY <br />CLOTHES WASHER <br />URINA� <br />i.rIINKING FOUNTAIN <br />FLOOFi DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BP.R/MOP/ETC.) <br />OTHER <br />�SUC <br />� LczH <br />CONTACTNAME <br />ADDRE55 ��iL �` �S <br />iL� ZP <br />/j-RLr,�%�" Gr/.%S <br />�jy2 23 <br />j� Building D Mechanical <br />PERMIT �j Combinalion B Plumbing <br />TYPE D Demolitien Sign <br />�> Sprinkier <br />J/ <br />PHONE <br />CONTR. LICENSE q <br />�✓,�sf�rG�cr�o J l <br />BAddilion I NEAT SOURCE <br />Alteralion � Electric <br />BNew Gas <br />Repair/Maint. Other <br />CITV OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />C„� Fun,�qc� 9- .�c,� <br />NO. I TYPE OF FIXTURE :1R REM <br />A/C -A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />3AS PIPINC <br />EXHAUST FAN <br />I HEHEBV CERITIFY THAT i HAVE READ AND EXAMINED THIS P"PLICATION AND KNOW THE SAME TO BE TAUE AND CORRECT. ALL <br />PROVISIONS OF U1WS AND OFIDINACES GOVERD:ING THIS TYPE OF WORK WILL 8E COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OA LOCAL LA'N REGUTATING CONSTFUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PR�PERTY TO PERFORM TNE WORK FPR WHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTOFiS LAW 78.27 RCW AND 296.200 WAC. <br />:-Z /'DZ <br />