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� <br />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 />LZ 2U c <br />LEGAL LOT NO. BLOCK <br />UESC. <br />OWNER <br />� <br />L��w <br />7E ANTNAME <br />CONTRA�]CTOR ,' <br />�JYc�O� Sir ti ��� 0 <br />PNONE � <br />PARCEL TAX I.D. # <br />TRACT <br />CONTACT FOR PERMII <br />��rookSit�i �I <br />ADDRESS <br />5yoo (S� <br />SH��,o,�, �..� <br />�l �v� S � Z�P <br />, <br />CJ << <br />, <br />�. ; � . <br />(j cl o� — v � <br /># <br />(J�-3b <br />PHONE <br />'Zl y/�SsS� <br />CONTR. LICENSE # <br />[3 �rok PP `I�3� <br />PROPOSED USE OF BUILDING Building Mechanical Addition I HEAT SOURCE <br />(� ( PERMIT Combinali0n Plumbing WORK Alteration R Electric <br />\�C.SG\'�� r�(h, 1 1'YPE Demolition Sign TYPE New �j Gas <br />Sprinkler RepairlMaint. U Other <br />CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAI" <br />CLOTHES WASHER <br />URINAL <br />DRINhING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <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 />RANGEHOOD <br />^ WATER HEATER <br />METAL FIREPLACE/STOVE <br />F;REPLACE INSERT <br />GAS FIREPLACE <br />GASRANGE <br />GAS F�PING <br />EXHAUSTFAN <br />OTHER <br />li I HEREBY CERITIFY THAT I HAVE READ AND E.`(AM1IINEU THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />� PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COIdPLIED WITH WHETHER S°ECIFIED HEREIN OR <br />'�, NOT. THE GRANTING OF A PERh11T DOES NOT PRESU�1e TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORh1ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />i OWNER OF THIS PROPERTY TO PF�RFOAM THE WORK FOR 1NHICH APPLICATION IS MADE AND I COMPLY WITH THE STA7E <br />CONTRACTORS LAW iB.Zd RCW AN� 296.200 WAC. <br />-\— _ 3 — <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />