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� <br />� <br />P��MIT <br />� <br />APPLICATIO� � <br />CITY OF EVERETT P�ERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425•257-8810 — FAX 425-257-8857 <br />SITE ADDfiE S <br />' % ' � � �. �,� �-t.� I .5 / <br />LEGAL LOT NO. BLOCK I <br />OFSC. <br />OWNER / / / <br />��" l, G� •/v �lr�t/L� � <br />TRACT <br />lJ1.Gn <br />PARCEL TAX I.D. # <br />TENANT NAME -IJ CONTACT NAME (C <br />v <br />CONTRACTOR ` ADDFESS <br />,d �)-tl �- � s�e, v r c� l��f,'� I� �;.�, , 3� l I 1 <br />PHONE �1 /- �J � Z `> j ' /� 1 b D 'l <br />PROPOSED CSE OF BUILOING <br />CCNTHACT PR�CE OF WORK <br />WORK DESCRIPTION <br />NO. � TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />�_ BATHTUB <br />_ LAVATORY (WASH BASIN) <br />SHOWER <br />T KITCHEN SINK & DISPOSAL <br />°�J DISHWASHER <br />� LAUNDRYTRAY <br />L— CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICEiBAR/MOP/ETC.) <br />_ OTHER_ _ <br />� <br />ZIP PHONE <br />PHONE <br />ZIP CONTR. LICF.NSE N <br />�� ; � ��, �"� � ✓' v1 �l C- i `� .�-c� r <br />Building Mechanical <br />PERMIT R Combinalion �. Plumbing <br />TYPE D Demqlilion Sign <br />U Sprinkler <br />� �9� c. 5 5.� l� �`� .G <br />y�Addition HEAT SOURCE <br />Alteration n Electric <br />BNew �� Gas <br />FepaidMainL L.J Other <br />CITY OF EVEqETT LOCAL SALES TAX COOE IS 3105 <br />IPIl3! <br />N0. I TYPE OF FIXTURE OR ITEM <br />NC –NHAND�ING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYFR <br />FANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPL4CE INSERT <br />CAS FIREPLACE <br />GAS PANGE <br />GAS PIPING <br />EXHAUSTFAN <br />1 HEREBV CERITIF'f 'HA71 HAVE READ AND EXA�dINED THIS APFUCATION AND KNOW THE SAME TO BE TqUE AND COFPECT. ALL <br />PAOVISIONS OF LAWS AND OHIDINACES GOVERNING THIS NPE OF WORK WILL BE CO�dPLIED WITH WHETHEA SP[CiFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF AN'! OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRl1CTION OR THE P[RFORAtANCE OF CONSTRUCTION. THAT I AM AUl"HORIZED 6Y THE <br />0',NNER OF THIS PROPERTY TO PERFORPA THE'NORK FOR WHICH APPLICATION IS M11ADE AND I COh1PLY WITH THE STATE <br />CONTRACTORS I.ASN 1827 RCW AND 296200 WAC. <br />