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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA ggp01 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS !� <br />e i' l/Y�fl—' <br />LEGA LOT NO. BLOCK <br />DESC. <br />OWNER <br />�Uel`eTf NouSlnb � <br />TENANT NAME <br />£H(3 <br />CONTpACTOR / � � <br />L <br />PHONE <br />PROPOSED USE OF BUILqNG <br />H 1�—'� <br />CONTRACT ppICE OF WORK <br />PARCEL TAX I.D. N <br />9 a -oo I -o 00 -Doo <br />TRACT <br />�.�•h�, 310'� C.�lyy �� <br />CONTA NAME <br />_�l %� �oNGu j <br />ADDRESS np <br />Building echanical <br />PERMIT R Combinetion Plumbing <br />TYPE D Demolition Sign <br />_ U Sprinkler (M ol heads) <br />Il� o��l- �z� <br />PHONE 4 ZS— <br />� so�-.sZc,� <br />PHONE <br />NiJ' <br />,so � -.lZ, c. / <br />CONTR. LICENSE k <br />Atldition <br />WORK Alteration <br />TYPE New <br />epeidMaint <br />HEAT SOURCE <br />Elettric <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />..vnnuW{�nlrllurv / <br />�`�' �►v�o d1�-(� i,.n- I� �,a �� c o►^-Q_ itio v-t �.�.,G <br />NO. � TYpE OF Fl%TURE OR ITEM <br />wATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN �II!K & DISPOSAL <br />UISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINK�NG FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />NO. � TYpE OF FlXTURE OR REM <br />_ 'vt�—wrIANULING UNITS <br />_ FORCED AIR SYSTEMS <br />_ HEAT PUMP <br />_ UNIT HEATERS <br />� CLOTHES DRY �Q�a�e_ <br />�, RANGE HOOD ��� <br />�1 WATER HEATER �^-Q— <br />_ METAL FIREPLACE/STOVE <br />_ FIREPLACE INSERT <br />_ GAS FIREPLACE <br />_ GAS RANGE <br />_ GAS PIPING <br />EXHAUST FAN <br />_ OTHER <br />I HEREBY CERITIFY THAT I HAVE fiEAD AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PRCVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFOR�17 THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />