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PERMIT APPLICATIdN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />£s� � s ,Y.� v� er- r�-:�� <br />SITE ADDRESS PARCEL TAX I.D, p �RMIT # <br />/o `0��- <br />LEGA LOTNO. BLOCK TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />GA.OGG ��`t'Ni✓.r'f �'0.�.� xA!'it.r G�is[y L'✓e: r�yJ,/s/p 1�F.z3 f�.a.� =3.i3 -,1Y1 <br />TENANTNAME <br />CONTRACTOR <br />PHONE <br />PROPOSEL USE OF BUI ING � <br />��,y � �.-+�+�,i..i"u`J�' PERMIT <br />TYPE <br />CONTACT FOR PERMIT <br />ADDRESS <br />�y Building <br />� � Combination <br />BDemolilion <br />Sprinkler <br />D Mechanical <br />BPlumbing <br />Sign <br />21P <br />PHONE <br />CON7R. LICENSE N <br />�Additlon <br />Nteretlon <br />New <br />RepairlMaint. <br />HEATSOURCE <br />�i ElecUic <br />B Gas <br />Other <br />CONTRACT PRICE OF WORK I CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />WORKDESCRiPTION /.�.¢�C.ci.�-C.� i/r� � ,�4-« ws��d 4'/c -W�`"/"-�'.�'twG�/�r l <br />/.l<-.iC(� .aZL�/�i—. 4// �L//s-�A1�ii/ �iL! .�c....r hiL•-rLZGc.v �C.G(:�G��a.'_�Y/- G! ,LC / <br />�/�v.. Gi��.[�[L•c".J�./i'cc�' .!p iJ�c..wf. � /j . ���Q4/ 2C'I'/ �ie�e Ll-LL4i �L J�2.:.:..�.:[ <br />f <br />NO. I TYFE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 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 />OTHER <br />NO.. I TYPE OF FIXTURE OR ITEM <br />A1C — 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 />GASRANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE ANU CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS 1'PE 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 AUTHORIZtD BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTQRS LAW iB.27 RCW AND 296200 WAC. <br />7-� J`f�r:.. -?' <br />/G i� }� ! 3 <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />