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P�tMIT APPLICATIO�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRESS Ef� S r <br />DESC. <br />LOT <br />BLOCK <br />/��%� /�.�G'Pr.:'T!� 5 <br />PARCEL TAX I.D. # <br />�i `3 / _ %v� �- <br />YiYSNY <br />77 U/ � <br />� <br />s-z�y-�oi6 <br />NANTNAME CONTACTFORPERMIT PHONE <br />� ,�o.v i/i/i��rf,�'F_�' 3Go-79�+-73aG <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE p <br />C-- �� � l/L= ATir1/<- c��: /i!/' S"Dd F--N:ST /�l i�, N <br />PHONE � � GS�/GI�r1I4/f%17 <br />/LTO�i�c�Fr `iS) L <br />PROPOSED USE OF BUILDING <br />�C' /71-7c=/_'/C �3-L <br />CONTRACT PRICE OF WORK <br />Building Mechanical <br />PERMi7 � Combination��Plumbing <br />TYPE Demolition Sign <br />Sprinkler <br />Addition I HEATSOURCE <br />WORK �Iteration i�Elearic <br />TYPE ew D Gas <br />RepaidMaint. U Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9705 <br />WORK DESCRIPTION <br />/�L s T/3G � �L� Sf G / ( <br />�,.o �Z�` �� j S Th'. i S <br />N0. � TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATIiTUB <br />LAVATORY (WASH BASIN) <br />�HOWER <br />KITCHEN SINK 8 DISPOSAL <br />OISHWASHER <br />LAUN�RYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICElBAR/MOP/ETC.) <br />OTHER <br />5 ; S.—Ef-r 5 ,Pvc : <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C—A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />I HEREOY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW �HE 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 PER'�11T �OES NOT PRESUMF TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHGRIZED BY THE <br />OWNER OF THIS 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 N'AC. <br />� I�///.5 L/in�.��P,fL,�L-" �—�� �GI � <br />DEBIT & CREDIT CARDS ARE NQT ACCEPl'ED <br />