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SITE ADDRESS <br />'/D ,�� <br />LEGA LOiNO. <br />DESC. <br />TENANTNAME <br />P�ERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />PARCEL TAX I.D. # <br />BLOCK TRACT <br />ADDRESS <br />��; fiC �'�i-y <br />ICONTA T FOR PERMIT <br />tf � . 1.. ,iti ��•, � <br />CONTRACTOR ���, f �C �� � � E G AUDRESS Su�� h� i Sh WL'i � <br />t <br />PHONE /.•i=i��7 l�G�"I<<�N <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />NO. I 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 (SERVICEIBAR/MOP/ETC.) <br />OTHER <br />Building D' Mechanical <br />PERMI7 B Combination ✓� Plumbing <br />TYPE g Demolilian U Sign <br />Sprinkler <br />PERMIT # <br />13s'9q13 <br />PHONE <br />CONiR. LICENSE # <br />�f�12 <br />Additlon <br />WORK Alteratlon <br />TYPE New <br />RepatrlMaint. <br />HEATSOURCE <br />D Electric <br />B Gas <br />ONer <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />NO. . I T�'PE OF FIXTURE OR ITEM <br />A/C — AIHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />AAETAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATICN AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING TNIS TYPE OF N'ORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION 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 PERFORAI THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW �8.27 RCW AND 296.200 WAC. <br />Signature of OwnerlContractor/Authorized Agent Date <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />