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� <br />PERMlT APPLICATION <br />CITY OF EVERETT PERMIT SERVIC�S <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - �FJC 425-25i-8857 <br />SITE ADDRESS <br />�,'.'\ ( L', lL )C � � <br />LEGAL LOT NO. <br />I '/ .�i I\.: L,l � ' <br />OWNER �� <br />f y!- <br />`. '� 1 C�C�( � 1' ��.� � 1 I llY� <br />TENANTNAME � <br />i�.�; !k <br />CONTRACTOR <br />PHONE �; � <br />PROPOSE� USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />PAP.CEL TAX I.D. # <br />�C.! I �i��(1C <br />TRACT <br />�� - I � � j C " �:,-i � <_. <br />ICONTACT FOR PERMIT <br />ADDRESS <br />Building <br />PERM.IY � Combination <br />TYPt DemOliliOn <br />Sprinkler <br />PERMIT # <br />�v"73v U M�y�3 —ta�2�1 <br />{ � � <br />G \5 � 11•/ <br />� ZIP HUNE <br />�_ • 7 <br />, , i,��e r.�%-� �- �-i� :�i;.,7 <br />Mechanical <br />Plumbing <br />Sign <br />20l <br />574�%Od <br />21P CONTR.LILENSEN <br />AdCition <br />Alleretion <br />New <br />RepaidMaint. <br />HEATSOURCE <br />Electric <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />i <br />,.,,_ ��,�Ic� ���.�;c.� I .;�(-� �,n:�l« 1��- ��� <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <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 />BACKFLQW PREVENTER <br />_ SINK (SERVICEIBAR/MOP/ETC.) <br />NJ. I TYPE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />� WATER HEATER <br />MEiAL FIREPL4CE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ ANO EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND OkIDINACES GOVERNING THIS TYPE 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 AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLii.ATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18 27 RCW AND 296.200 WAC. <br />_�� . �/ �z.—. _ / /� � ��' -/�s� <br />DEBIT 8 CREDIT CARDS ARE N6T ACCEPTED <br />