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SlTE ADDRESS <br />,��` p� <br />LEGAL LOT NO. <br />DESC. <br />OWNE <br />� �� <br />ENANTNAME <br />CONTRACTOR <br />G•1s/� �/— <br />PHONE <br />PROPOSED USE OF BUILOING <br />5 ��� <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />�9�1� <br />f��R;MIT ApP�.ICATIUR? <br />C:!TY OF EVtRETT PERIAIT SERVICES <br />3200 CEDAR STREET, EVERET'f, WA 98201 <br />425• 257-8810 – FAX 425-257-8857 <br />/T—g <br />BLOCK <br />PARCEL TAX I.D. # <br />TRAGT <br />° O �S /Ofi �� / <br />CONTACT FOR PERMIT <br />ADDRE55 <br />8uilding Mechanical <br />PERMIT R Combination R Plumbing <br />7YPE D Demolilion � Sign <br />L� Sprinkler <br />ZIP <br />PERMIT # <br />F� <br />CONTR. LICENSE # <br />Addition <br />WORK A.!teration <br />TYPE New <br />Repair/Maint. <br />HEATSOURCE <br />D ElecVic <br />�� Gas <br />U Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />. ��Q C� �l/t /L Ci C1L- rlJ/ �< `, <br />NO. I TYPE OF FIXTURE OR ITEM <br />� <br />� <br />� <br />� <br />� <br />� <br />WATER CLOSET (TOILGT) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINf<ING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />NO.. I TYPE OF FIXTURE OR ITEM <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 />�G GAS PIPING <br />EXHAUSTFAN <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 -i HIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION Uf ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />ON�NER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />DEBIT & CREOIT CARDS ARE NOT ACCEPTED <br />