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� cRMIT APPLICATIJN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />H ,�� <br />SITE ADDRESS I PARCEL TAX I.D. # P MIT a <br />i�r�� /;���ne�,G��r n��c�l ,�rs37��c,c,a-io�r �3Q.��iz� <br />LEGA LOT N0. <br />DESC. <br />OWNER <br />(_�_!� f_7a= �, <br />TENANTNAME <br />CONTRACTOR <br />CG C% 1=/'- �zT �v <br />PHONE <br />�,�5- ���3 7 <br />PROPOSED USE OF BUII <br />BLOCK I TRACT <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />l �� r[�-�..��y(C �� <br />, .� <br />� �� t ��—��' �` i� <br />'^� PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />i';�WATER CLOSET <br />4 BATHTUB <br />�4 �LAVATORY (WASH BASIN) <br />° SHOWER <br />� KITCHEN SINK 8 DISPOSAL <br />� DISHWASHER <br />�1 LAUNDRY TRAY <br />' �: CLOTHES WASHER <br />T URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />.� <br />� <br />NAME <br />PHONE <br />% <br />ADDRE55 ZIP CONTR. LICENSE M <br />� i��Y �3� �z $,t 98zC8 CG�1�Tht1 C�,� yC' <br />�tling � Mechanical <br />PERMIT Com6ination Plumbing <br />TYPE Demolilion Sign <br />Sprinkler <br />L <br />Adddion HEATSOURCE <br />WORK Atleralion Electnc <br />TYPE <br />Repair/Maint. Other <br />CITV OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />��ic, 2Z35 <br />NO. I TYPE OF FIIRURE OR ITEM <br />A/C — FVHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />fiANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFV THAT I HAVE READ AND E?CAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE ANU CORRECT. ALL <br />PROVISIONS OF LAWS AND OAIDINACES GOVEFNING THIS NPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A FERhtIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LASN REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF TH1S PAOPERTY TO PERFORM THE WORK FOR'NHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACT.Q(a5 LAW 1827 RCW AND 296.200 WAC. <br />��G <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />