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� f� <br />P�RMIT APPLICATIC�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAF STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />LEGA LOTNO. BLOCK <br />DESC. <br />OWNER <br />SA2AH 30 UE' j' <br />TENANTNAME <br />CUNTRACTOR � �M ,/�T/�� <br />'7 <br />PHONE //�s-.� SC�-/GGd <br />7 �o <br />PROPOSED USE OF BUIIDING <br />CONTRACT PRICE OF WORK <br />PARCEL TAX I.D. # <br />TRACT <br />a 3 U 7 /h �QaG�AG • EVRi, <br />CONTACT FOR PERMIT <br />ADDRESS <br />Building D Mechanical <br />PERMIT � Combination U Plumbing <br />7YPE Demolition U Sign <br />Sprinkler <br />ZIP <br />PERMIT p <br />Mo�-lci-G/ � <br />`�15-,� SF - p 7 � <br />PHONE <br />CONTR. LICENSE M <br />n Addltion <br />�-� Alle2tion <br />� .� New <br />L� RepalrfMaint. <br />HEATSOURCE <br />D Electric <br />B Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TN( CODE IS ]705 <br />WORK DESCRIPTION R�-Pt�«- � n� o uE yfl5 F(J/L/J19 �'� <br />N0. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHLVASHER <br />LAUN�RY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREV[NTER <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 />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />1 HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <NOW THE SAME TO BE TRUE AND CORRECT. AlL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WIL� BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOL4TE 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 />OWNER OF THIS PROPERN TO PERFORM TF1E WORK FOR WHICH APPLICATION IS MA�E AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 78.27 RCW AND 296.200 WAC. <br />1n.�0 � /n � / - 8-�y <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />