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�ERMIT APPLICATI�vN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS PARCEL TAX I.D. #� <br />�a4o G�aN�vrE1,�J AVC <br />LOT NO. <br />�,�� � Ha Roso� <br />TENANTNAME <br />Nor occ�lpr E� <br />BLOCK I TRACT <br />CONTRACTOR <br />PHONE w"RK D�N� <br />PROPOSED USE OF BUILO�NG <br />F%br-t E <br />CONTRACT PRICE OF WORK <br />3220 %1 � AVE NE MAR7�vI.(.�E <br />CONTACT FOR PERMIT <br />owNE2 <br />ADDRESS <br />'�Y OW►.��tL <br />Building Mechanical <br />PERMI7 � Combination Plumbing WORI <br />7YPE Demolition Sign TYPE <br />Sprinkler <br />ZIP <br />�a-dci3 <br />33�1-44Zo�(p� I <br />PHONE <br />CONTR. UCENSE N <br />f"') Addltion <br />KNtaration <br />�._l New <br />L� RepairlMaint. <br />HEATSOURCE <br />D Electric <br />B Gas <br />otner <br />CITY OF EVERETT LOCAL SALES TAX CODE IS �705 <br />WORK DESCRIPTION <br />'�Pc.,4c� Ex�sr�NG EG-ECT2fC Fu2nJacE Cv�T/a 6As Fu,euAcE, <br />f�(ovsE HAS Hab GAS ��RN/K.0 IIJ TN� �AAs3-, <br />NO. � TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <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/BAWMOPIETC.) <br />OTHER <br />NO. . I TYPE OF FIXTURE OR ITEM <br />A!C — AlHANDLING 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 />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORR[CT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOL4TE OR CANCEL THE PROVISIO� OF ANY OTHER <br />STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 7 RCW AND 296.200 WAC. <br />���C��� A„�� (o/z9�3 <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />