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PERIIi�IT APPLICATION <br />CITY �F EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />DESC. <br />OWNER <br />s <br />TENANTNAME <br />CONTRACTO <br />'�0��12 `S �-hS�S,oC��,.� <br />PHONE <br />D USE OF BUILDING <br />�r Cy <br />�foM� A <br />CONTRACT PRICE OF <br />PERMIT <br />TYPE <br />WORK DESCRIPTiON J��'(� NA�lU <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 (SERVICE/BAR/MOP/ETC.) <br />PARCEL TAX I.D. p <br />ADDRESS <br />�ti <br />CONTACT <br />ADDRESS <br />PERMIT k <br />p�l` d/ /0 -0�7 <br />PHONE <br />35��-°! � <br />PHONE <br />CONTR. LICENSE # <br />BBuilding Mechanlcai Addltlon HEAT SOURCE <br />Combinelion R Plumbing WORK B Aiteretiun � Eiectric <br />BDemolition � Sign TYPE New Gas <br />Sprinkler Repair/Meint. Othar <br />^ CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />�z-t�L- b� P� />� 5�� ✓�- - <br />NO. � TYPE OF FI7(TURE OR 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 />MEfAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />EXHAUST FAN <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 S ANO ORIDINACES GOVERNING THIS IYPE OF WORK WILL BE COMPLIED WITH WNEfHER SPECIFIED HEREIN OR <br />NOT. TH GRAN OF PER�d1T DOF� NQT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE O IILA GU TING CONSTRUC i IQIJ OR THE PEfiFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OONT � /'/, � 7 ANO 96M 0 WqpOR' OR WHIC�� LIQATION I� DE AND I COMPLY WITH THE STATE <br />/� � a7c'l <br />'�� Z ���a� r <br />