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SITE ADDRESS <br />NO. <br />CO�ITRA�TOR� � <br />l��,o ,� , ,.r,' <br />PHONE <br />PROPOSED USE OF BUILDING <br />. ��` ���' <br />CONTRACT PRICE OF WORK <br />P�RMIT APPLiCATI��� <br />CITY OF EVERETT PERMIT SER`✓ICES <br />3200 CEDAR STREET, EVERETT, WA 98_01 <br />425-257-8810 - FAX 425-257-8857 <br />� <br />TRACT <br />PARCEL TAX I.D. # <br />FOR PERMIT <br />ZIP <br />3oa q I�1�'s,/ ��'fla�� iP I%P,•,/ l�� �..�° <br />Building Mechanical <br />PERMIT � Combinalion � Plumbing <br />TYPE Demolition Sign <br />Sprinkler <br />WORK DESCRIPTION <br />� <br />"li:� � I � i -• %. <br />PLUMBING <br />N0. TYPE OF FXTURE OR ITEM <br />� WATER CLOSL•T (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />� SliOWER <br />: I KITCNEN SINK 8 DISPOSAL <br />LAUNDRYYRAY <br />CIOTHES WFiSHER <br />URINAL �� <br />DRINKING FOUNTAM„ <br />FLOOR DRAIN <br />BACKFLOW PREVENTER'�� <br />SINK (SERVICE/BAR/MOP/E7i .) <br />OTHER �� <br />N0. <br />CONTR. LICENSE # <br />Addition <br />WORK � Alteralion <br />TYPE New <br />Repair/Mainl. <br />HEATSOURCE <br />Electric <br />Gas <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3�05 <br />TYPE OF FIXTURE OR ITEM <br />A/C—AIHANDLING UNITS <br />FORC�D AIR SYSTEMS <br />HcAT PUMP <br />NIT HEATERS <br />CL THES DRYER <br />RAN HOOD <br />METAL <br />GAS FIREPLAC <br />G.4S RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />I HEREBY CERITIFY THAT I NAVE READ AND E�Ah11NED THIS APPLICAI'ION AND KNOW THE SAME TO BE TRJE AND CORRECT. ALL <br />PROVISIONS OF LAWS ANU OFIDINACES GOVERNING THIS -YPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRFSJME TO GIVE AUl'HORITY TO VIOLATE OR CANCEL THE PROVISION OP ANY OTHER <br />STATE OR LOCAL LAW REGUWTING CONSTRUCTION OR Th'E PERFOF2MANCE OF CONSTRUCTIO�. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR 1NHICH API�LICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 78.27 RCW AND 296.200 WAC. <br />Signature of OwnedContractodAuthonzed Agent Date <br />DEBIT 3 CREDIT CARDS ARE NOT ACCEPTED <br />�L <br />