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PERMIT APPLICATIO�i <br />CITY OF EVERETT PERMIT SE�VICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 (, -3 1-b � <br />SITE ADDRESS PARCEL TAX I.D. # FERMIT � <br />511 LA�1tz�-L �PFz • C�SlaZO0000G4C0 1�� pjp ��� <br />LEGAI LOT N0. <br />oEsc. �� L�AL <br />OWNER <br />"iDM I—fOS�Af� <br />TENANTNAME <br />'t'OM 1�-bi��N <br />CONTRACTOR <br />PHONE <br />PROPOSED USE OF BIJILDIN(i <br />j2.�=��� f�1 G�. <br />CONTRAI;T PRICE OF WORK <br />TRACT <br />511 (�.LN�C� 't�S .' . , �V�3�1"T" <br />I CONTACT FG ?ERMIT <br />a+�-r �-4a �.c_ <br />ADDRESS <br />Building D Mechanical <br />PERMIT R Combination U Plumbing <br />7YFE ��Demolition U Sigr <br />�� Sprinkler <br />-YPE <br />PHONE <br />425• 25�•08�8 <br />ZIP CONTF. L!GENSE 7? <br />n Addilian HEAT SOURCE <br />(-� Alteration I � Eleciric <br />V' ( New �a` <br />�( <br />U RepaiHldainL Other <br />CITY OF EVERETT LOCAL SALES TFX CODE IS 3105 <br />WORK�ESCRIPTION ���/�f>lc�i�- �/�,� /F!/'�."�/�/� <</"/�i�•�- <br />NO. I TYPE OF FIXTUF2E OR ITEM <br />WATER CLOSET (TOILET) <br />BA7HTUB <br />LAVAiORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDR�TRAY <br />CLO7HES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />F�GOR DRAIN <br />BACKFLOW F'REVENTER <br />SINK (SERVICGBAR/MOP/ETC.j <br />OfH[R <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - A/ HAN DL W G U N ITS <br />�ORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STO\'E <br />FIRFP�ACE INSERT <br />GAS FIREPLACE <br />_ GAS RANGE <br />_ GAS PIPING <br />_ EXHAUSTFAN <br />OTHER _ <br />I HEREBY CERITIFY "(HAT I HAVE READ AND EXAAiINED THIS APPLICATION AND KNOW THE SAA4E TO BE TP.UE AND CORRECT. ALL <br />PROVISIGN3 OF :i\WS AND ORIDINACES GOVERNING THIS TYPE OF WOFK N9LL BE COM1iPLIECI WITH WHETH'cR SPECIFIED HEREIN OR <br />NOT. TNE GRANTING OF A PERMIT DOES N0T PRESUM14E TO GIVE AUTHORITY TO VIOL?SE OR CANCEL THE PROYISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCe OF CONSTRUCTb�N. THAT I AM AUTHORIZFD BY THE <br />OWNER OF/ 'PI1S PROPEP.TY TO PERFOR�t THE WORK FOR N'HICH APPLICATION IS �dAD'c AND ! COMPLY WITH THE STATE <br />rntiraanc�iRs`sa`N 18.27 RCW fiND,296200 WAC. <br />[o Z�J • <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEP7ED <br />