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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES ? <br />3200 CEDAR STREET, EVERETT, WA 98201_� <br />425-257-8810 - FAX 425-257-8857 <br />�0 //I -oog <br />SITE ADDRESS PARCEL TAX I.D. 0 PERMIT X <br />v o0 8 oo soc C // - °c' <br />LEGA BLOCK TRACT <br />2 <br />DESC. <br />LI OtG 0690-00 L.^.'c A J. J1.a A oL.-f- <br />TENANT NAME <br />3� <br />CONTACT NAME <br />ZIP PHONE <br />--C2 r <br />PHONE <br />CONTRACTOR ADDRESS ZIP CONTR. LICENASrEr0 <br />PHONE � le'4j'on-CC,'hios-e>v.� 7?Or - �0 -p y�, �. �'u' -tt oJII N/'/ o7o3G <br />h(9t,.e.sv- 57" /-'z Tsrads- <br />PROPOSED USE OF BUILDING <br />ee <br />Building Mechanical <br />I PERMIT Combinalion Plumbing <br />Addition <br />WORK Alteration <br />MEAT SOURCE <br />n Electric <br />TYPE Demolition Sign <br />(TYPE New <br />-�iLFJjX`•Gas <br />Sprinkler <br />Repair/Mainl. <br />Other <br />CONTRACT PRICE OF WORK PRICE OF WORK <br />�TK �O CITY OF EVERETT LOCAL SALES TAX CODE IS 7105CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />-....----........ JG-41st. ttousG s*4 O ar)c -I T64St>F0MT (-Vmf tSA4—cC) <br />ti,jc 2�t' $� ASAtt 11. ey-I9.7-AU; <br />NO. i t TYPE OF FIXTURE OR RM <br />WATER CLOSET <br />_ BATHTUB <br />LAVATORY (WASI I BASIN) <br />SHOWER <br />_ KITCHEN SINK & DISPOSAL <br />_ DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />_ BACKFLOV%'PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />}N6• I TYPE OF FIXTURE OR ITEM <br />we - A/FIANULING UNITS <br />FORCED AIR SYSTEMb <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 />EXHAUSTFAN <br />__ OTHER <br />1 HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT 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 AUTHORIZED BY THE <br />OWNER OF 1I1IS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />