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PF'�MIT APPLICA�IC�J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />j � 425-257-8810 - FAX 425-257-8857 <br />�-_�--�`� <br />SIT° ADDRESS I PARCEL TAX I.D. # I PERMiT a <br />/��" _r— r-r�r-�t � i��c� -`.�� i i����r �-:5��� _ 9.�•�ok �3 7 S�� 3 <br />NAME <br />CONTRACTOR <br />�c��r���' <br />PHONE _ ^ � ^ <br />NAME <br />PNONE <br />ADDRESS LP CONTR. LICENSE 8 <br />1���� %ric• /i��Y ������--Sr qgsr� �o�,cT,�1��vc <br />PROPOSED USE OF BUILDINGr ing Mechanical Adtlition HEAT SOURCE <br />PERMIT Combination � Plumbing WORK Alteration Electric <br />TYPE Demolitian Sign TYPE <br />Sprinkler Repair/Maint. �r <br />CGNTRACT PRICE OF WORK qTY OF EVERET7' LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />� ���'�?n�L! � <br />� <br />;.� x <br />IYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />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 (SERVICE/BAWtv10P/ETC.) <br />_7 <br />J <br />,�i'occ, 2Z3S <br />NO. I TYPE OF FlXTURE OR REM <br />A/C — rVHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HFATERS <br />CLOTHES DRYER <br />ftANGE HOUD <br />WATER HEATER <br />METAL FIREPI.ACE/STOVE <br />FIREPLACE IN3ERT <br />�iAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBV CERITIFV THAT I HAVE REAO AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CGRRECT. ALL <br />PROVi510N5 OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIFO HEREIN OR <br />NOT. TNE GRANTING OF A PEFMIT DCES NOT PRESUh1E TO GIVE AUTHORITY TO VIOL4TE OR CANCEL THE PROVISION GF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />ObVNER OF THI PROPERTY TO PEFiFORM THE :YORK FOR WHICH nPPLICATION IS MADE AN� I COMPLY WITH THE STATE <br />CON7RAC S L/9lV 7827 RCW AND 296.200 WAC. <br />/ G' .. � if . ,n r —r <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />