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P�.FiMIT APPLICATIL.� <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 />z3a � � � S <br />IEGA LOT NO. <br />DESC. <br />OWNER <br />G c� ��;' F1 I� i V <br />TENANTNAME <br />sti�� <br />CONTRACTOR <br />PHONE �/� �- <br />PROPOSED USE OF BUILDING <br />�` "" <br />CONTRACT PRICE OF WORK • <br />WORK DESCRIPTION <br />PARCEL TAX I.D. N <br />BLOCK I 7RAC7 <br />�1�eN '�3cK Sz � <br />�� I CONTACTNAME <br />rJ � `� e <br />A�DRESS <br />I�c�1C <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATEf± CLOSET <br />BATHTUB <br />_ LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLGW PREVENTER <br />_ SINK (SERVICE/BAFVMOPlETC.) <br />_ OTHER <br />Building Mechanical <br />PERMIT R Combinalion R Piumbing <br />TYPE D Demolilion � Sign <br />D Sprinkler <br />IPERMIT 8 <br />ZIP PHONE <br />(J ST.SI.;, `'1 �Zv� /+�� �1�n4� <br />PHONE <br />('d �'lC ! �Oti <br />ZIP CONTR. LICENSE N <br />Addilion FIEAT SOURCE <br />WORK Alleration j� Eleclric <br />TYPE New '� D Gas <br />Fepair/Maint. � Other <br />CITY OF EVEREfT LOCAL SALES TAX CO�E IS 3105 <br />NO. I TYPE OF FlXTURE OR ITEM <br />_ A/C—PJHANDLINGUNITS <br />_ FORCED AIR SYSTEMS <br />_ HEAT PUMP <br />_ UNIT HEATERS <br />_ CLOTHES DRYER <br />_ RANGE HOQD <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'HAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO 6E TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PqESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL tAW FiEGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTjiA�TORS LAW 78.:7 RCW AN� 296200 WAC. <br />