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I�RMIT APPLICATI� N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425•257-8810 - FAX 425-257-8857 <br />/l7 -i S -D Z <br />SITE ADDRESS PARCEL TAX I.D, il PERMiT: <br />��. � �..�:; �' L�S�a - DO l- p oo -o OD y�YY�c;� lf� �U,�:� <br />LEGA LOTNO. BLOCK I TRACT - <br />DESC. <br />'/ I�baSI�IG , <br />TENAN7NAME <br />� N �9 <br />CONTRACTOR £' N /!� <br />PHONE <br />�"n�-� GG <br />PROPOSED USE OF BUIL�ING <br />CONTRACT PRICE OF WORK <br />�,! -la�Co/�� �Ib'.lu/ <br />CONTA— CT� <br />�/II L�iN6:-� <br />AO�RESS <br />3,0�- ��,��,� 9�-��� <br />a� ��i2za� <br />PHONE <br />�-Jti•��l �GG/ <br />ZIP CONTR. LICENSE 4 <br />Building ��/( Mechanical Adtlition HEATSOURCE <br />PERMIT RI--( Combina�ion L) Plum6ing WORK {R--( Alteralion n Eieclric <br />TYPE �J Demolilion U Sign TlPE �j New �1 Gas <br />� <br />u Sprinkler U Repair/Maint. LI Other <br />'r� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK OESCRIPTION O.. `��) /� � ,� <br />�ur ,J G c <br />NO. I TYPE OF FIXTURE OR ITEM <br />WFlTER CLOSET <br />BATHTUB <br />I LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />� _ DISHWASHER <br />��� LAUIJDRY TRAY <br />CLOTHES WASHER <br />I _ URINAL <br />�� DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />_ SINK (SERVICEiBAR/MOP!ETC.) <br />OTHER <br />NO. I TYPe OF FIXTUFE OR ITEM <br />�_ <br />/ <br />A/C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER � IG � <br />RANGE HOOD A�lo � � <br />WATER HEATER ��'-p �-�-` <br />METAL FIREPLACE/STOVE <br />FIAEPLACE INSERT <br />GAS FIREPLACE <br />GASfiANGE <br />GAS PIPING <br />EXHAUST FAN iV P � <br />OTHEF <br />I HEFEOY CEFiITIFY'HAT I HAVE f7EAD AND E;(AP.IINED THIS APPLICATION AND KNUV! THE Sdh1E TO BE TRUE AND COPFECT. ALL <br />PROVISIONS OF L;1W5 AND OfiIDINACES GOVERNING THIS TVPE OF WORK WILL BE COM11PLIED WITH WHETHER SPECIFIEG HEFEIP! OR <br />NOT. THE GRANTING OF A PERP.IIT DOES NOT PRESUAIE TO GIVE AUTHORITY TO VIOLA'iE OF CANCEL THE PROVISICN OF ANY OTHER <br />STATE OR IOCAL lAW REGULITING CONSTI7UCTION OR THE PERFORh1ANCE OF CONSTFUCTION. THAT I AM �UTHCRI�ED BY THE <br />OIVNER OF THIS PROPERTY 70 PERFORM THE WORK FOR WHICH APPLICATION IS M1IADE AND I COP.IPLY WITH THE STATE <br />CONTRACTORS LAW 182i RCW ANO 296200 `NAC. <br />