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PERMIT APPLICATf�N <br />CITY QF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET. EVERETT. VdA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />I SITE ADDRESS <br />� (r �' ti / <br />�I ���CV 'C �, i l '1� <br />LEGAL LOTNO. BLOCK <br />UESC. <br />ON'NER <br />i�� '- <br />' .Ci�7/.. �/A(./W� �r��.r'�'<•.� <br />ITEIJANT NAIAE <br />� <br />i COyiRACTOR <br />� /!�,/«r. /,�A„��,,��./� <br />PfiONE <br />�i.� 5�•:% -d'S4 t"— <br />TRAC7 <br />PAP,CEL TAX I.D. x <br />FOR PERMIT <br />ADDRESS <br />/�9c �c'Y�'�� .I�_� .<'.�_ <br />YtHfdil 1 <br />J30G05 � C�c <br />ZIP ?HONE <br />.'G i' %�'S -0'S-? -15J�/ <br />PHONE <br />21P CONTR.UCENSER <br />�O.fC�J .iLiC.�1,�=(yf.�. <br />PROPOSED USE OP 6UILDING ��1''`(jj```��� BuilCing Mechanical Addition HEAT SOURCE <br />PERMIT � Combinalion R Plumbing WORK � AP,aration � E�ectnc <br />NP[ Demolition ❑ Sign 7YPE New � Gas <br />iSpfinklef Repairtldainl. O1her <br />CONTRACT PRICE OF WORK �: ;/ /i�,�� LITY OP EVERETT LOClLL SALE£ TAX COJE IS 3105 <br />_ �� S�� <br />WOR�K DESCR/IPiION <br />/U51/:�� (�/l�ii�,i�e ii� ic� Cr/,� �� / (i'i�_:-C�fi.j�('�C /! �i.,t <br />� �� �� �v' <br />NO. I T�'PE OF FIXTURE OR REM <br />N'ATER CLOSET <br />BATHTUB <br />LAVAIDRY (lq�/1SH Bl�SIN) <br />SHOWER <br />KITCfiEN SINK 8 DISPOSHL <br />DISHWASHcR <br />LAUNDRY TRF�Y <br />CLOTHES VJ�SHER <br />URINAL <br />DRINKING FOUNTAIN <br />fLOOR DR�IN <br />BACKFLOW PREVENTER <br />SINI< (SERVICclBARIIdOPlETC.) <br />OTHER_________ ___ <br />NO. I TYPE OF FIi.TUP.E OR ITEM <br />NC -AIHANDU'JG UNITS <br />FORCED AIR S1'STEMS <br />HEAT ?U�,�P <br />UNIT HEATERS <br />CLOTHES DR\'ER <br />RAIJGE HOOD <br />WATER HEATEk <br />IdETAL FIREPLhCE'STOVE <br />FIREPLACE INS=RT <br />_ GAS FIREPLf+CE <br />GASRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />' HEREBY CERITIfY THAT I HAVE REAU AN� EXAA11NeD THIS APPLICATIOW AND KtJOW THE SAA1E 70 BE iRUE AND CO3RECT. FLL <br />PROVISIONS OF LA1V5 AN OFI ACES GOVERNING THIS IYPE OF WORK WILL BE COMPUE� N4TH N'HETHER SPEGPIcU 4EREIN OR <br />NOT. T HE G4AN1 W G OF�A PERM T DOES NO i PRESUI,7E TO GI\'E AUTHORITY 70 VIOLATE OR ChNCEL TME PROVISION OP ANY O i HER <br />ST�IE OIQ�JGlL LAW f"GUL4i G CONSTRUCTION OR 74E PERFi)RIJANCE OF CONSTRl1CTION. THPT I Ald AUTMORIZGD dY THE <br />ON'NEf7 OF 1 HIS :OP 2iY T���ERFJRId THE \4'OhK FOR ri'HICM A-PLICAIION 13I.7ADE AND I COtdPLV N9T�I THE STATE <br />COViFAC70RS LA N 7 �✓(i(:SNl�NU �9F>200 Wf.C. <br />� �� �' 7 <br />SW�t�faof rl nntrar.InrlAulhnnzeA Aoent fl.��n <br />DE61T & CREDlT CARDS ARE NOT ACCEPTED <br />