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PERMIT APPLICA � IaN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 . <br />425-257-8810 — FAX 425-257-8857 :,.;t�� ��'/'7 �I <br />��i I <br />DRESS <br />��co. 4'Y4, <br />LOTNO. � BLOCK <br />oesc <br />TRncr <br />PARCEL TAX I.D. # <br />PERMITN <br />i���Z�� �i� <br />����� ��� � I <br />O�YNER /iwrtwa ur rnvnc � � <br />f�� � o;t-�' U-1.a��s' .zvtil, n„-Ft�.,.,.�t- L l.. 4. 1443� �' ��o„v� �1,,.-�tn�, t2l C�z 9�� � <br />TENANTNAM[ CONTACTFORP[RMIi V�,V �U'j-(p1ElEE���„r.�3�� � <br />1_ 1 1 /�/�� <br />\/!l�l. �'1 .�.i,! I.:i�i fli1�/1 �� O'/ln IP� IMeY� V1��.�•%QQ ���'� I I <br />CONTRACTOR <br />PHONE <br />PROPOSED USE OF BUIL�ING <br />I1DDR[SS <br />� <br />i <br />f �, i� ('( l�/ ��_ <br />i <br />�uilding <br />PERA7IT R Combination <br />TYPE D Demolition <br />__1 U Sprinkler <br />CON7RACT PRICE OF WORK 1� G(JD -f <br />RP�lechanical <br />PiumMnc� WORI <br />d Sign 7YPE <br />21P CONTR. LICENSE # <br />f"1 Addition <br />�� Alterahon <br />I ) New <br />D RepairiM11aint <br />HEATSOURCE <br />U Eiectnc <br />Gas <br />other <br />�� ��t.G I CITY OF EVERETT LOCAL SALES TAX CODE IS ]105 <br />WORK UESCRIPTION � <br />��� �G,P��r��/ ���dG��iL�n� <br />tJ <br />� <br />�t� <br />TYPE OF FIX7URE OR IT[M <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH OASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHN�ASHER <br />LAUNDRY TRAY <br />CLOTH[S WASHER <br />URINAL <br />DRINKING FGUNTAIN <br />FLOOR DRAIN <br />BACKFLOW r'REVENTER <br />SINK (SERV;CElBAR/MOP/[TC.) <br />OTHER <br />NO. I TYPE OF FI%TURE OR IT[M <br />A/C - AlHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEATPUMP <br />UNIT HEATERS <br />CLOTIiES DRYER <br />RANGEHOOD <br />'�IATER HEATER <br />METAL FIREPLACElSTOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER _ <br />� I HERFBY CERITIFV THAT I HAVE RHAD AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRLE AND CORRECT. ALL <br />I PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPfl OF WORK WILL BE COMPLIED VVITH WHcTHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PER�dIT DOES NO I i�RESUME TO GIVE AUTHORiTY TO VIOIAI'E OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSlRUCTION OR THE PERFORMANCE OF CONS fRUCTION. TNAT I AM AI:THORI�EO BY THE <br />' OWfJER OF THIS PROPERTV TO PLRFORM THE WORK FOR WHICN APPUCATION IS MADE AND I C01.iPLV 4'�iTH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296 200 WAC. <br />i Signature of Owner/ContracloVAuthonzed Agent Date <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED � �G1 <br />