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PERMIT APPLICATIOlV <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-25 � -8857 <br />�'n� O�l-C.i 7 <br />SIT�6RESs � ��� I pARCEL TAX I.D. # I PERMiT s <br />a �' <br />LEGAI.� LO7 NO. ( <br />�ESC.� <br />OWNER <br />���ue�� �e�e� <br />TENANTNAME <br />^'� <br />CONTRACTOR <br />PHOIJE <br />PROPOSED USE OF BUILDING <br />CONTHACT PRICE OF WORK <br />WORK �ESCRIPTION <br />— a�unneir <br />NO. I NPE OF FI7(TURE OR REM <br />BLOCK I TRACT <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWEH <br />KITCHEN SINK & DISPOSAL <br />_ DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKF�OW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />PERMIT <br />TYPE <br />CONTACT NAME <br />��A <br />ADDRESS <br />�Building <br />Combination <br />Demolilion <br />Sprink�er <br />Plumbing <br />Sign <br />�' <br />��v ` <br />I�:[�7:1� <br />z� <br />21P CONTR. LICENSE N <br />RAddi�ion I HEATSOURCE <br />Alteralion j� Electric <br />BNew � Ges <br />Repair/MainL Gther <br />CITY OF EVEREfT LOCAL SALES TA7C CODE IS 3105 <br />N0. � TYPE OF FlXTURE OR ITEM <br />n/l: — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYCR <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />1 HEPEBV CERITIFY'HAT I HAVG HEAD AND EX}1MINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PFOVISIONS OF I.aWS AND DRIDINACES GOyERNING THIS 1YPE OF \VORK WILL BE COIAPLIED WITH WHEfHER SPECIFIED HEREIN O.^. <br />NOT. THE GRANTING OF�� PERMIT DO[S NDT PRESUME GIVE AUTHORITY TO VIOLATE OF CANCEL THE PROViSION OF ANY OTHER <br />STATE OF LOCAL LAW AEGULATING C_ON 'I'HUCTION O� HE PERFORMANCE OF CO TRUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF THIS�PROpERTYSO�PEliFO THE WORK OR WHICH APPLICATI N IS DE AND I COMPLY W�TH THE STATE <br />CONTRACTORS L1� 8 i FCW AND 99200 WAC. �� <br />;' i�� ��` �` Tl / ��" D Z-, <br />C, C� I�O �{ -c� I 7 <br />