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�' PERMIT APPLICAI ION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRESS <br />LEGAL LOT NO. BLOCK <br />DcSC. <br />OWNER <br />S%E✓E ELkE <br />TENANTNAME <br />CONTRACTOR <br />s�,,;� cuNs;xurnc,� <br />PHO E <br />(��25} -� 37�'j�•5� <br />PROPOSED USE OF BUILDING I <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />PARCEL TAX I.U. # <br />TRACT <br />fo 2g o��e�,✓ �c <br />CONTACT FOR PERMIT <br />ADDRESSrj 2 S�. <br />�0%27-21— � <br />EvF.�E'�TT tvq qkzo8 <br />PERMIT <br />TYPE <br />�� <br />�Building Mechanicai <br />Combination � Plumbing <br />Demoiitlon Sign <br />Sprinkler <br />I �1�.. j ►a -�� <br />21P PXQNE <br />Cs�`�} <br />r. 9gzo� 3ss�9i� <br />PHONE <br />ZIP CONTR. LICENSE M <br />C- iS'�'r, i <br />Additlon I HEAT SOURCE <br />WORK R Alteration � ElecVic <br />TYPE � New Gas <br />L> RepaidMainL Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS ]105 <br />/1� � w fThZ T�/ N�l Ex-c'��f,��E (�vc� r,.�r��� � <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <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/BAR/MOP/ETC.) <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC — AIHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOO� <br />WATER HEATER <br />METAL 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 APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF IAWS 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 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 ?ROPERN TO PERFOR�1 THE WORK FOR WHICH APPIICPTION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTQfi& LAW 1�.y7 RCW ftND 2�6.Pp0 WAC. <br />/ ,Of�'0 � <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />