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P�RMIT APPLICATI�nI <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />,� � , 5 �. <br />LEGA LOT N0. <br />DESC. <br />OWNER / <br />� �� L—CJ� ` <br />TENANTNAME <br />CONTRACTOR <br />PHONE <br />PROPOSED USE OF BUILUING <br />1�V�� � <br />r <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />���✓ C � / <br />BLOCK � TRACT <br />NO. � TYPE OF FIXTURE OR ITEM <br />F .RCEL TAX I.D. it <br />3 FS IIYIG..� <br />CONTACT FOR PERMIT <br />ADORESS <br />Building DMechanical <br />PERMIi R Combination B Plumbing <br />TYPE D Demolition Sign <br />U Sprinkler <br />V`� — (LF�d � <br />WATER CLOSET (TOILET� <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOW ER <br />KITCHEN SINK E DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTIIER <br />TYPE <br />PERMIT # <br />Q �y'na - az I <br />ZIP PHONE <br /><<Zl -Z <br />��DO� ��72 <br />PHONE <br />ZIp CONTR. LICENSE # <br />AdOilion <br />Alteratlon <br />N <br />RepairlMaint. <br />HEATSOURCE <br />Electnc <br />Gas <br />Olher <br />CITY OF EVERETT LOCAL SALES TAII cout �s 7iw <br />NO. I TYPE OF FIXTURE OR ITEM <br />A1C—A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEATPUMP <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 />OTHER _ <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAM1IWED THIS APPLICATION AND KNOW THE SAME 70 BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVER�ING THIS Tl'PE OF 1h'ORK N9LL BE COMPLIED WITH WHETHER SPECIPIED HEREIN OR <br />NOT. THE GRANTING OF A PERhiIT DOES NCT PRESUAIE TO G�VE AU7HORITY TO VIOL4TE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE ?=RFORAtANL'E OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OV✓NER OF T IS PROPLERTY/i0 PERFORM THE WORK FOR WHICH AP?UCATION IS A1ADE AND I COMPLY WITH THE STATE <br />CONTR , S�Wl18,27�CW AND�9fi^.00 WA�.. 2/I > I^ l/ <br />� <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />