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�'ERMIT APPLICAI �ON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 982G1 <br />425-257-8810 - FAX 425-257-Sd57 <br />SITE A�DRESS <br />SC' L =e.�� tir <br />L_GP. LOTNO. <br />DESC. <br />�c,1 �� j v <br />TENANT� <br />CONTRACTOR '' <br />( �,�4l� <br />PHONE <br />PROPOSE� USE OF BUILDING <br />% - ( "� <br />L . ✓�r1 � - `l 1 �� <br />CONTRACT PRICE OF WORK <br />PARCEL TAX I.D. # <br />BL� K TRACT <br />��S`� ( � �c,� � r <br />CONTACT�OR PERMIT <br />�n6�✓ ��nQ'� � <br />D� <br />Building [�/ MecPianical <br />PER�d1T P Combinalion U Plumbin� <br />TYPE �i Demolition U Sign <br />U Sprinkler <br />PERMIT : <br />rh o3 ia-oc <br />i /�S �s"E-w�l.E / <br />PHONE <br />�,��'.�!S �i S L'jU <br />ZIP CONTR. LICENSE # <br />Addition <br />WORi( Alteration <br />TYPE New <br />Repair/Maint. <br />HEATSOURCE <br />Electric <br />Gas <br />Other <br />CITf OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK OESCRIPTION I <br />�I // i <br />�� 7Vi.J �Gy �'�'/I% �'�fl�/// � �/�'✓ C7�'> �17.�'�/� (�;,/' �� ��f I <br />/ <br />�,,,<l �, C'� �1,�,; - � y %,.. /�,:�.���, � /s�� �!-�� Cus ���/ /�� �/%�. � j <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />L4VATORY (VdASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />UFINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/M190P/ETC.) <br />OTHER <br />NO. I TYPE OP FIXTURE OR ITEM <br />A/C - WHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />11NIT HEATERS <br />CLOTHES DRYER <br />RANGEIi00D <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACFINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PiPING <br />EXHAUSTFAN <br />I HEREBY CERITIFY TNAT I HAVE READ AND EXAtdINED THIS APPLICATION AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNWG THIS TYPE UF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />I IJOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />' STATE OR LOCAL LANJ`REGUTATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />0�'N67� OF THIS PRO,�ERTY TOj�E� RM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONfRACTOR�LAW 1827 RCW AAI� 296.200 WAC. <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED �� J� '�I v^� - <br />