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P��2MIT APPLICATIOtiV <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />OCJ� J U r GL � <br />LEGA LOT NO. BLOC� <br />DESC. <br />OWNER <br />i/�.IL//l- <br />TENANT NAME <br />CONTRACTOR <br />PHONE /' _ /%�� / /� _ <br />�C 11�/t-�'l.c.�- -1—rJ� <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />WORK OESCRIPTION / / <br />� _' <br />�Q,(,C nUt �T z �1'�- <br />�W�na� s � .5 <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILETj <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/BARIMOP/ETC.) <br />PARCEL TA7( I.D. # <br />TRACT <br />CONTACT FOR PERMII <br />A�DRESS �3 7�S 7 Z _;/ <br />i <br />u �,e � ��.� ,� <br />Building Mechanical <br />PERMIT R Combination R Plumbing <br />7YPE Demolition � Sign <br />Sprinkler <br />� i`�i �l°S � 310 <br />Z�P PHONE <br />y�s3S3-os�U7 <br />PHONE <br />21P CONTR. L�CENSE A <br />��, ^- 9�°oa- <br />�aoS/�Sz�S�' <br />�Addition HEATSOURCE <br />Alleretlon [� ElacGic <br />New �,.j Gas <br />RepaidMaint. !] Other <br />CIN OF EVERETT LOCAL SALES T/V( CODE IS 9105 <br />i?��G(.!/�_ - � �,.�/� v�L � rr- <br />/ � <br />��� <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C-AIHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEATPUMP <br />UNIT HEATERS � � <br />CLOTHES DRYER � <br />RANGE HOOD i_ on p� <br />WATER HEATER (/�� �d <br />METAL FIREPLACE/STOVE <br />FIREPLACEINSERT �� <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I I HEREBY CERITIFY THAT I HAVE REAO AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />'� PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITN WHETHER SPECIFIED HEREIN QR <br />�� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME 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 AUTHORIZED BY THE <br />I� OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1B.27 RCW AND 296.200 WAC. <br />Signature of Owner/ContractodAuthonzed Agent Date <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />