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� ERMIT APPLICA?��JN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425•257-8857 <br />s�e aouRess <br />2l� 13 (�R/�+�D A-UE, 5E <br />LE6A lOT NO. BLOCK <br />DESC. %�${ 5 �'.df�s 61$ � -po <br />�o(-f�1 �FI�S WEZ� <br />TENANTNAME <br />CONTRACTOR <br />o��N�2 <br />PHONE <br />PROPOSED USE OF BU�LdNG <br />S I �� 6C.� �l}►,-i c �, <br />I2E 5 • <br />PARCEL TAX I.D. ! <br />00 4t3 9 r 61 spo 6 0� <br />R <br />TRACT <br />�-vr12�:� �cll� of %�(.(C b15_ D- �o <br />i��23_lti� � SE aP 4L5 Y8b- <br />SNa I�M►sN R&L5` 3961 <br />CONTAC7NAME PHpNE <br />ADDRESS <br />Building Mechanical <br />PERMIT Combinetion � Plumbing <br />TYPE Demolllion Sign <br />Sprinkler <br />CONTRACT PRICE OF WORK � SOO ^ <br />WORK OESCRIPTION <br />I�I�n �C I � l'v/t��� <br />r'� � �M eTzR <br />NO. � TYPE OF fl1CTURE OR REM <br />WATER CLOSET <br />PATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER, <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />UfiINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/DAR/MOP/ETC.) <br />OTHER <br />ZIP CONTR. UCENSE 1 <br />Additian NEAT SOURCE <br />Altaretbn � Electric <br />New Oas <br />RepeidMeint. OIMr <br />CT' OF EVERETT LOCAL SALEB TA% CODE IS �106 <br />�v� N�j�Tld�l <br />NO. � TYPE OF FlXTUqE OR ITEM <br />A/(: — AlFIANDLINQ UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />OAS FIREPIACE <br />GAS RANOE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CEFiITIFY THAT I NAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND COHRECT. ALL <br />PROVISIONS OF LAWS AN� ORIDINACES GOVERNING THIS TVPE OF WOflK WILL BE COMPUEO WITH WHEiHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO 61VE AUTMORITV TO VIOLATE OR CANCEL THE PROV�SION OF ANY OTHER <br />S7ATE OR AL LAW REGUTATING CONSTRUCTION OR TF1E PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZEO BY TME <br />OWNER OF . IS PFiOPERTY TO PERFORk THE WOFK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRAC7��),�'W 18.27 FCW AND 296.200 WAC. <br />�� <br />� <br />