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LOT N0. <br />TENANTNAME <br />pERMIT APPLICATIbN <br />C'TY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />�e J <br />BLOCK <br />CONTRACTOR. �q�W�y i'{P1{+"15 <br />PHONE <br />3Cv0• 5� S oi (o' <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />S <br />NO. I TYPE OF FIXNRE OR ITEM <br />PERMIT <br />TYPE <br />WATER CLOSET (TO�LET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWHSHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOPIETC.) <br />OTHER <br />pARCEL TAX I.D. # <br />TRA�T <br />ICONTACT FOR PERMIT <br />AODR[:SS <br />PERMIT # <br />Yv�o 3Qq-oi °� <br />21P PHONE <br />j �lZi'2.$%• (Z��/ <br />PHONE <br />Z�p CONTR. LICENSE # <br />q o ZS` �•.] �••• G ci.b otu �c N Rir <br />SrnYa���Jh 4g2G0 KM <br />BBuilding Mechanical <br />Combination Plumbing <br />[� Domolition Sign <br />U Sprinkler <br />CITY OF EVERETT LOCAL SALES TAX CCDE IS 7105 <br />Q Addition <br />WORK Id'A�te tlon <br />7ypE D New�cice <br />U RepairlMaint. <br />G- *,F O�C_►' �- <br />HEATSOURCE <br />Eledric <br />Gas <br />Olher — <br />NO.. I TYPE OF FIXTURE OR ITEM <br />A/C – A/HANDLING UNITSwA`L <br />� FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACEISTOVE <br />FIREPIACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />N e�.-ti/ <br />I <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. AL <br />PROVISIONS OF LAWS AN� ORIDINACES GOVERNING THIS.TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />S ATE OR LOCALILAW REGUTATING �ONS kUCTION OR T�E PERFORMANCE OF CO STRUaCT ON.0 HAT AM AUTHIORIZED BY � E ER <br />OW NE ROFnRS LAW P8.2 RCW A DF 96 200 WACORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THe STATE <br />7.• <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEP`CED <br />