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i- ERMIT APPLICAT�JN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />S�TE ADDRESS PARCEL TAX I.D. # <br />s�oc� �.o�,�.S�— ys�a- ooi-000-000y <br />LEGA LOTNO. BLOCK TRACT <br />�„-9-�t1 (d..� w <br />TENANT NAPdE <br />��-w <br />CONTRACTOR � `/ � <br />�� <br />PHONE <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK �',.D O <br />3�0�- c.�i6y �tsa�� <br />JNTACT NAME ' <br />� i I l Lo.,. G�,2� <br />ADORESS <br />Building echanical <br />PERMIT � Combination Plumbing <br />TYPE Demolilion Sign <br />Sprinkler <br />WORK OESCRIPTION !I� � <br />��o'£./?-d�+�+-0<Mr�a4.. fX�3'f'��"7 <br />NO. I TYPE OF FIXTURE OF ITEM <br />WATER CLOSEi' <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />N0. <br />PERMIT M <br />M��-o� <br />PHONE <br />3o3/r�3 <br />PHONE <br />5 a I-5� c. I <br />ZIP CONTR. LICENSE k <br />�ddilion <br />teralion <br />New <br />Repair/Maint. <br />HEATSOU9CE <br />Electric <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />� <br />TYPE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER ��L <br />RANGEHOOD P1+-��P�— <br />WATER HEATER �t� �""� <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />8AS FIREPIACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBV CEaITiiY THAT I HAVE READ AND EXAMINED THIS APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL. <br />PROVISIONS OF v1�VS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREI'J OF <br />NOT. THE GRANTING OF A PERPdIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PfiOVISiON OF ANY i1THEF <br />STATE OR LOCAL LAW FEGULATING CONSTRUCTION OF THE PERFORMANCE OF CONSTRUCTION. THAT I AM11 AUTHOP12ED 8`! THE <br />OWNER OF THIS PFOPER7Y TO PERFORPd THE WOiiK FOR WHICH APPUCATION IS h1ADE AND I COh1PLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />