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P�RMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREEI', EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />Sl�a— <br />SITE ADDRESS <br />� < <br />LEGA LOT N0. <br />DESC. <br />OWNER <br />—� <br />., , c. <br />BLOCK ' I TRACT <br />PARCEL TAX I.U. # <br />TENANT NAME � I CONTACT FOR PERMIT PHONE <br />CONTRACTOR (�(����4��; `� ADDRESS'���� ��` UGl 9�73 CONiR. LICENSE# <br />(`nE�.z� mS.� l, 3CP'1 <br />PROPOSED USE OF BUILDING Building [� Mechanical Addition HEAT SOURCE <br />?ERMIT B Combination U Plumbing WORK �i Alleration � ElecUic <br />TYPE D Demoiition L� Sign TYPE D New Gas <br />U Sprinkler U Repair/Maint. Other <br />CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />WORK DESCRIPTION <br />�,�c.,9k � i� BoSo �co�u�r.ac.e nnb a,�j�o� 41e �..�- <br />NO. � TYPE OF FIXTURE OR ITEM <br />WnTER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRA�N <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BARIMOP/ETC.) <br />OTHER <br />N0. I TYPE OF FU(TURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHFS DRYER <br />RANGE HOOD <br />WATER HEATER <br />MEiAL FIREPLACE/STOVE <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIP�NG <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AN� EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK `NILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES fJOT PRESIIME TO GIVE AUTHORITI` TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGUWTING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATIUN IS MADE AND I COMPLY WITH THE STATE <br />CbNTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />\���r.�,��4 �1�c��k���—}1u:� �.k.���,�yv.,� ��-^�-o� <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />