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PEh2MIT APPLICATIOiv <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 />3l J,3 �/a-ss�� <br />LEGA LOTNO BLOCK <br />DESC. /'l � %,3 �� 2 <br />PARCEL TAX I.D. # PERMI7 # <br />Da �.37.r �.32 �/� o n o3 �,yoc <br />TRACT O i <br />✓ /r7� �L[Lf <br />ce.T ���P�.-��.r, yo2�- ��yt �-, �io s�� E� ����i .3.3y-d8� <br />' �'_ <br />TENANT NAME � I CONTACT FOR PERMIT PHONE <br />y�s)ss9-�8�8 <br />'/v/R- (� �.-, c To h n s o,--, �o.:..� u-, S/�.7-•3.D3 -/ 7 <br />CONTRACTOR ���� ADDRESS ZIP� �CONTR. LICENSE p <br />PHONE <br />PROPOSED USE OF BUILDING <br />• I PERMIT <br />���� ��. TYPE <br />CONTRACT PRICE OF WCRK <br />WORK DESCRIPTION <br />��a-,� h^..`�C� <br />.� "��"„� <br />NO. � TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (IVASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLGOR DRAIN <br />BACKFL.OW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />Building <br />ombination <br />Demolitian <br />Sprinkler <br />�Mechanical <br />Plumbing WORI <br />Sign TYPE <br />� <br />� <br />� <br />� <br />Addition <br />Alteratlon <br />New <br />Repair/Maint. <br />HEATSOURCE <br />Electric <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7705 <br />��i �x-�-��'y`" /�i .-,eJ 1��y.�� <br />�x t�u4�.J p_,�„� b�.4.,., . <br />NO. I TYPE OF FI%TI;RE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEhIS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS R.4NGF <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 ORIDINACES GOVERNING THIS TYPE OF WORK WILL BF COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. 7HE GRAN7ING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TME PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT � AM AUTHORI�cD BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WI7H THE STATE <br />CON7RACTORS LAW 18.27 RCW AND 296.200 WAC. <br />6/7, <br />)I <br />