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PERMIT APPLICATI�iN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERElT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRESS � _ / <br />�jc�oS ��e� <br />LEGA� LOT NO. BLOCK <br />DESC. <br />OWNER <br />I /CnCQ �ti- <br />TENANT NAM <br />CONTRACTOR <br />PHONE � p � ��-S� <br />PROPOSED USE OF BUILDING <br />s r=�'�- <br />CONiRACT PRICE OF WORK <br />PERMIT <br />TYPE <br />�ARCEL TAX I.D. # <br />TRACT <br />ADDRESS <br />CONTACT FOR PERMIT <br />ADDRESS <br />BBuilding Mechanical <br />Combinalion � Plumbing <br />BDemolition Sign <br />Sprinkler <br />ZIP <br />O.s�l� - <br />PHONE <br />CONTR. LICENSE p <br />Pddition <br />WORK Alteratlon <br />IYPE �Jew <br />Repair/Maint. <br />HEATSOURCE <br />Electric <br />Gas <br />�Ihe� <br />CITY OF EVERETT LOCAL SALES T/U( CODE IS 9105 <br />WORK OESCRIPTION f <br />�i�R n.� M � �C� SC' c%e,U -Lt-ito%'l�l. � G� ��-- %`��/�( ��P — � <br />CJ �J <br />NO. I TYPE 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 />FLQOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C-AIHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT Pi1MP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACEISTOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS R.4NGE <br />GAS P�PING <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 (AWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMI7 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTNORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM1I THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 78.27 RCW AND 296200 WAC. <br />SignaWre of Owner/ContraclodAuthonzed Agenl Date <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />