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SITE ADDRESS <br />LOT NO. <br />DESC. <br />Y I'ERMiT APPLICAl"ION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 x G3 � a <br />BLOCK � TRACT <br />PARCEL TAX I.D. # <br />PERMIT # <br />-� � ., . <br />r I�� I�C I I �ICJ U Si /,J � �I,1 I I�� PHONE <br />TENANT NAME I COI.TACT FOR PERMIT <br />_ . __1_,,.. Z.P CONTR. LICENSE # <br />CONTRACTOR �� <br />PHONE �/ �� <br />b <br />`/ <br />����6���� <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />WORK OESCRIPTION <br />N0. I TYFE OF FIXTURE OR ITEM <br />D Building Q M�echanical <br />peRM1T �% Combination �t�'�umbing <br />TVPE �j Demolilion U Sign <br />U Sprinkler <br />i WATER CLOSET (TOILET) <br />j BATHTUB <br />i LAVATORY (WASH BASIN) <br />SHOWER <br />� KITCHEN SINK & DISPOSAL <br />� DISHWASHER <br />LAUNDRYTRAY <br />�_ CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICEiBAR/MOP/ETC.) <br />OTHER <br />�ddi6on <br />Iteretion <br />New <br />ftepairlMaint. <br />HEAT SOl1RCE <br />Electnc <br />Gas <br />Other <br />CITY OF EVERETT LOGa� ar+��� ��`^ """� •� " <br />NO. I TYFE OF FIXTURE OR ITEM <br />A/C-A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />� WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER — <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAAIINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE ANu t;unrce� i. r��� <br />PROVISIONS OF LAN15 AND ORIDINACcS GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />S�TE OR LOCALILAW REGULATING CONS RUCTION OR T�HE PERFORMANCE OF CO STRUOCT ONNCTHAT AM A�UTHORI ED BY O E FR <br />OWNER OF THIS PROPERN TO PERFOR�A THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH 7HE STATE <br />CONTRACTORS LAW 1827�W AND Z°6200 WAC. <br />� / , � �. L-/' C� <br />DE81T & CREDIT CARDS ARE NOT ACCEPTED <br />