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� <br />�fftM�T APPLi�A�fON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAf2 STREET, EVEREiT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />S!TE ADDRESS <br />R <br />� � . L 7 �' <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />� Ci�'��'� �1'Y1 � \ <br />� TENANTNAME <br />� CONTRACTOR !_��lym�� � <br />PHONE <br />�I25-�1�1-8S�I1 <br />PROPOSED USE OF BUIL�ING <br />__......._.....___. .._.... � i-I <br />PARCEL TAX I.D. # <br />C_10� �Sf O I OC <br />9LOCK TRACf <br />ADDRE55 <br />�� �� � �I cfis �-IU��t� C.�, � <br />ICONTACTFOR RMIT <br />� �v�� n ��rT7 6 LI <br />1 [a <br />AODRE55 � <br />2l'I � ti1 (r' c� �>ivi_ c.� ziP <br />l�lr:n�lu�CT�'irC�Ce ���13 <br />Building echanical <br />PERMIT B Combination Plumbing <br />'TY.>E Demolition � �Sign <br />Sprinkler <br />. i� �,� <br />WORN OESCRIPTION <br />��.�c�� pt����(� C.��ar�tc�e�crcc,� <br />� <br />�YPE9FtlXitlRE9R� �fiEM <br />WATEP,CLOSET <br />BATHTUB <br />LA`✓A'ORY (NlASH BASI,Y) <br />SHOWER <br />�KIFCHEN�SINK B�DISPOCAL <br />DISHWASHER <br />LAUNORYTRAY <br />�GLOTHES�WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />�FLOOR�DRAIN <br />9ACKFLOW PREVENTER <br />SINK (SERVICFJBAR/MOP/ETC.) <br />OTHER <br />PHUNE <br />S 7���`�'i��� <br />CONTR. LICENSE A <br />C�YI`lPirl TOOL0�7 <br />Atldi�ion � HEATSOURCE <br />Alteration I �Electric <br />New Gaa <br />Repair/Maint. pther <br />�CIT-Y�OFEVERETr�LOCALSALES TAX-0ODEIS 376T <br />�NO. �I -fiYPEOF-PUtTURE9R�ti£M <br />NG -AMAN�LING UNITS <br />�FORCED AIRSYSTEMS <br />HEAT Pl1MP <br />UN4T YEATERS <br />�CLOTHES�DRVER <br />RANGEHOOD <br />WATER HEATER <br />METAL �FI REPLAC EJSTOVE <br />FIREPLACE IMSERT <br />GAS FIREPLACE <br />�GAS�RRNGE <br />GAS PIPING <br />EXHAUSI'FAN <br />OTHER <br />�I�HER'cBY£ERITIFY THAT�iMAVE�READ AND EXAMINED SHIS APPUGATION AND-KiYOW FHE�SAME TO�BE TRUE AND�GORREGT. A6L <br />PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WMETHER SPECIFIED HEREIN OR <br />tJOT. THE GRANTING OF A PERMIT DOES NOT PRFSUME TO GIVE AUTHORITY TO VIOLATE OF CANCEL THE PROVISION OF ANY OTHER <br />.STATE.UR LQCAL.LqYJ REGUTATING90NSTRUCTION.OR Tt1E PERFORMANCE.OF.CONSTRUCTION. THAT.I.gM.9VIHORIZE0.8Y TNE <br />OWNER GF 7HIS PROPEP.TY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AN� 1 COMPLY WITH THE STATE <br />CONTRA�76fiS LAW 18.27 RCW AND 296.200 WAC. <br />C <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />