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PERMIT APPLICATION <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 />3 � � � /Vcl SSci w <br />PARCEL TAX I.D. # PERMIT ri <br />00 Y.3�.f �-.�y oio DD 1�i0`{C <br />LEGAL 3{.owNO.�o��P, p BLOCK TRACT <br />DESC. �ir yo� �E��..-��- ��� H P��t <br />Au o�,��- �� �3?� <br />OWNER ADDRE55 ZIP PMONE /� .�/—jJff� <br />C� � J Pr'o� �-�S� �r y�o s� Nb y t f►-v �� #/0 5�� Ev�-��}-� �fF 9� I <br />TENANTNAME I CONTACTFORPERMIT PHONE <br />' �/FI- I L,he.-i� .Tohnto» `12r-3�f-b'8BB <br />(Dsu�r� f��,T•�03' <br />CONTRACTOR ��hp�J ADDRESS ZIP C TR.LICENSEN I% �� <br />PHONE <br />PROPOSED USE OF BUILDING <br />PERMIT <br />��,� �y�� TYPE <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION , <br />�-r�.,�d.�..: :..; t J <br />� � <br />40. I TYPE OF FIXTURE OR ITEM <br />� <br />� <br />Building <br />Combination <br />Demolition <br />Sprinkler <br />RMechanical <br />Plumbing WOR! <br />D Sign TYPE <br />� <br />� <br />� <br />� <br />Addition <br />Alteration <br />New <br />RepaidMaint. <br />HEATSOURCE <br />Eledric <br />Gas <br />othe� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />n.c.w./4. C*l7.li�.� Ev'C.c.c�t �i r�/ .�-��: <br />`�� ,-�yCt—�—c_.� Q.c�c� �d �� <br />WATER CLOSET (TOILET) <br />BATHTUB <br />L4VATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR GRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAfLMOPIETC.) <br />OTHER <br />NO. � 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 />r1ETAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GASRANGE <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 LAWS AND ORI�INACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HERE�N OR <br />NOT. TFiE GRANTING OF A PERMIT DOES NOT PR'eSUME 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 />O\NNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 78.27 RCW AND 296.200 WAC. <br />%���� ��/ i�171�%'�/ �o / %/� Y� <br />DEBIT 8� CREDIT CARDS ARE NOT ACCEPTED <br />