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SITE ADDRESS <br />LOT NO. <br />TENANTNAME <br />� <br />�; <br />�RMIT APPLICATI�N S�u ;�3 - o�� <br />CITY OF EVERETT PERMIT SERVICES �R-,� �3-�� <br />3200 CEDAR STREET, EVERETT, WA 98201 �nA ��_ p3 � <br />425-257-8810 - FAX 425-257-8857 <br />DI,� 3v(o- Oa0 <br />//�/f-� i <br />CONTRACTOR �I� L � n � <br />l� <br />PHONE `/V I/� <br />PROPOSED JSE OF BUILDING <br />PERMIT <br />TYPE <br />CONTRACT PRICE OF WORK <br />PARCEL TAX I.D. # <br />q?�Ib 0100 <br />TRACT <br />AD RESS <br />r �2 ���s a�Y-�� <br />�CONTACT FOR PERM�T /� �,�,i�, � <br />�nM�zr 1� a�a <br />ADDRESS <br />�Building � Mechanical <br />Combinalion Plumbing <br />Demalition Sign <br />Sprinkler <br />� <br />PHONE <br />CONTR. LICENSE k <br />Addltion <br />WORK Alleratlon <br />TYPE New <br />RepairlMaint. <br />HEATSOURCE <br />ElecVic <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORKDESCRIPTION LRC�IS"�'r ��.L�(��� L��T�� �uG%�y ��rO�Df�I�b <br />LYIGIL <br />�•�� %� �f�. I�TY�IGf/t� �x.1��9tcE fl�,��v uv/�-1d�71Nb <br />NO. I TYFE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />A/C — AlHANDLING UNITS <br />FORCED AIR SYSTEMS <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 RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERITIFY THA' I HAVE READ AND EXAMItJED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILI BE COMPLIED WITH WHETIIER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUh1E TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISION JF ANY OTNER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK POR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />Signature of OwnedContracrodAuthonzed Agent Date �la <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />