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SITE ADDRESS <br />LOT N0. <br />PERMIT APPLICATIOnI <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />BLOCK I TRACT <br />PARCEL TAX I.D. # <br />PERh11T # <br />i�'10�{ p�{ -0/$ <br />�';�.�_Uy HA�c ,���5 Oc..k��- ��� �isao� vas�asa� s�-as <br />TENANTNAME CONTACTFORPERMIT PHONE <br />f����Y H�t'�L <br />CONTRACTOR <br />�C �7 fLC6 <br />PHONE <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />ADDRESS ZIP CONTR. LICENSE # <br />N�RL-pLA��"E 50G� /�\A�N MONRoE� w'i} <br />NC. I NPE OF FIXTUR[ OR ITEM <br />WATER CLOSET (TOILET; <br />BAiHTUB <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/BA,2�MOP/ETCJ <br />OTHER <br />Building D Alechanical <br />PERMI7 R Combination U Plumbing <br />TYPE Demolilion U Sigr. <br />Sprinkler <br />Addition <br />Alteralion <br />New <br />Repair/Maint. <br />NEATSOURCE � <br />Q Electnc I <br />�f Gas <br />U Clher <br />CITY OF EVERETT LOCP�_ SALES TAX CODE IS J705 <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 />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />� HEREBV CERITIFY THAT I HAVE READ AND EXAh11NED THIS APPLICATION AND KNOW 7HE SAME TO BE TRUE AND CORRECT. AlL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH INHETHER SPECIFIED HEREIP, OR <br />NOT. TnE GRANTING OF A PERMIT DOFS NOT PRESIRdE TO Glb'E AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF AP:Y OTHER <br />STATE OR LOCAL LAW REGUWTING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUC710N. THAT I AM PUTHORI2ED BY THE <br />� OWNER OF THIS PROPERTY'O PERFORM THE WORK FOR N'HICH APPLICA?ION IS MADE AND I COM1IPLI' WITH THE STATE <br />I C�ON,T�/RACTORS L�A%`� 1827 RCIV AND 296200 6'JAC. <br />I C�X _dl'.. �Ll:� /�n �i' !,�' o�% <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />