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DFSC. <br />P�RMIT APPLICA�ION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETf, WA 98201 <br />425-257-8810 - FAX 425-257-8857 , <br />� _ �-1-a y , <br />2EI S PARCEL TAX I.D. # — I P/ER�MiT � I <br />�� � j� E- � __� b / �iJ� –�-�c�– II <br />LOT NO. BLOCK TRACT I <br />TENANTNAME <br />O% Co// <br />CONTACT FOR PERMIT <br />CONTRACTOR ADDRESS <br />YJt�-r/l' S S� �2 v i� f- �� ��-r �i � I <br />P"�"` 3�{/I l�ir2o /-t ek r��/e <br />PROPOSED USE OF dUILUIN� BUilding I� MeChanical <br />PERMIT COmbinati0n j�; Plumbing <br />TYPE Dem01ili0n LJ Sign <br />Sprinkler <br />CONTRACT PRICE OF WURK <br />WORK DESCHIPiION <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISFOSAL <br />DISHWASHER <br />LAUNPRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIf� <br />BF.CKFLOW PREVENTER <br />SINK (SERVIC[/BAR/MOP/ETC.) <br />- `�� Z � �— <br />PHONE <br />ZIP CONTR. LICENSE # <br />O�c'�5/�i(�s�B <br />ACdilian HEAT SGURCE <br />WORK �Alleration � ciectric <br />TYpF New Gas <br />RepairlMaint. Olher <br />CITY OF EVERETT :ACAL SALES TAX CODE IS 9105 <br />NO. I TYPE OF fIXTURE OR ITEM <br />� <br />A/C – A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />NEATPUMP <br />UNIT FIEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACElSTOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />AL <br />I HEREBY C[RITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW'HE SAME TO BE TRUE AND CORRECT. ALL <br />P30VISIONS OF LAWS ANG ORID:NACES GOVERNING THIS TYPE OF �h'ORK WILL 6E COMPLIED W�TH VVNETHER SPE.IFIED HEREIN OR <br />NOT. THE GRANTING OF A PERM1IIT OOES NOT PRESUM1IE TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVI; �ON OF ANY OTHER <br />STATE OR LOCAL LAW REGl1LATING CONSTRUCTION OR THE PERFORh1ANCE OF CONSTRUCTION. THAT I AM AUTHORIZEQ BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE 1NORK FOR WHICH i.PPIICATION IS MADE AND I COMPLY WITH THE STATE <br />CON7RACTORS LAV' 18.^<7 RC1V AIJD 296.2001YAC. <br />� / <br />� ���v����/%i/I:�G--'7 °) — `�— C� `. <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />q <br />