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P�RMIT APPLICATIO�I <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 />�{ O� �11 i� CiV� <br />LEGAL LO NO. B� <br />DESC. L�-' � c �! <br />OWNER <br />�u� i �,�! 2 . Nr�i•��' <br />TENANTNAME <br />� S�� <br />CONTRACTOR <br />�x�.�_ <br />PHONE <br />PROPOSED USE OF BUILDING <br />G'u-r c� �j-�,�U7iUTY <br />PARCEL TAX I.D. l� <br />aA�G - nn�- <br />�r <br />CONTACT FOR PERMIT ' <br />� a�. <br />ADDRESS <br />Salv���` <br />Building Mechanical <br />PERMIT R Combination R Plumbing <br />TVPE Demolition � Sign <br />B Sprinkler <br />CONTRACT PRICE OF WORK 1 S �0 <br />2 <br />ZIP <br />PERMIT # <br />CONTR. LICENSE N <br />Addition <br />Alteratlon <br />New <br />Repair/Mainl. <br />HEATSOURCE <br />Electric <br />Gas <br />Other <br />_ I CITY OF EVERETT LOCAL SALES TNC CODE IS 3105 <br />WORK DESCRIPTION <br />A�� D;-r � e r� '�o E+� � s� o� Ga. r�j� 4v� U-+�� l:, {-y � O o M <br />� �ts s, F, <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 />CLOTHESI,NASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — A/HANDLING 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 FIREFLACE <br />GASRANGE <br />GAS PIPING <br />� EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND E>(AMINED THIS APPLICATION AND KNQW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF L4WS AND ORIDINACES GOVERNING THIS TYPE OF IVORK WILL BE COA7PLIED WITH WHETHER SPEGFIED HEREIN OR <br />NOT. THE GRANTING OF A PERAIIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE FERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH r�PPLICATION IS MADE AND I COMPLY WITH THE STATE <br />�CTORS LAIN 18.27 RCW A ID 2��% �/'AC. <br />,�i���l�� �z� o <br />3f[,�na ure of Owner/Contr r/Authonzed Agent ate �/ <br />� <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />