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P�RMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, Wf, 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />I[41 <br />'ENpMT NAME • <br />C'ly�t �uH�Gr,t•-- <br />COF(�RACTOR /,� � 7� �; � .G�w <br />��'V F� �IGI <br />PHONE �ZS• Z� ! • �I � <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />PARCEL TAX I.D. p <br />1 0 D 2 000 Od � <br />BLOCK TRACT <br />3 D. Do <br />ADD ESS <br />5/os �lilrl'!lhe1�7Y► <br />I CONTACTFORPER <br />/�G ADDRESS T.# !LV /�)M. i/ <br />rV P/Il (GV`7 %. <br />�l/G�G� <br />( <br />Building Mechanical <br />PERMIT Combination R Plumbing <br />TYPE Demolition � Sign <br />Sprinkler <br />21P <br />9d10(0 <br />tt <br />PHONE <br />259 �zs� <br />CONTR. LICENSE N <br />qurt��bl9IPsC7 <br />�Ctlition <br />Iteration <br />New <br />Repair/Mainl. <br />HEATS URCE <br />r <br />��� �O _ I CITY OF EVERETT LOCAL SALES TAX COUE IS 3705 <br />6 <br />WORKDESCRIPTION �I�� ��j� ry � <br />1 A� h w�u� - <br />NO. I TYPE OF FIXT�RE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WAS: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 />BACKFLOW PREVENTER <br />SINK (SERVICE/BARlMOP/ETC.) <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — AlHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CIOTHES 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 />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF lAWS ANJ ORIDINACES GOVERNING 7H15 NPE OF WORK WILL BE COM1IPLIED'�41TH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVP AUTHORITY TO VIOLATE Oft CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL L'a1'✓ REGUL4TING CONSTRUCTION OR THc PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />01'VNER OF THIS PROPERTY TO PERFORM THE WORK FOR �VHICH PPPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS WW 18.27 RCW AND 296.2DO 1M1'AC. <br />�i»^� YtcPi�- . 2 . v /z <br />Si naWre of OwnerlContractor/Authonzea Agenl Date <br />DEBIT 8 CREDIT' CARDS ARE NOT ACCEPTED <br />