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PERMIT APPLICATIC�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETr, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />-� Z-t - S S�'- S�t' <br />LEGAL LOT NO. <br />S l,,C/ <br />BLOCK <br />PARCEL TAX I.D. # <br />l�0`1pd3�pbD-Dl <br />TRACT <br />Sea�,.� �s� Es�o,,�'es <br />-bD � ��, ��-�.,;-,_� <br />1_ c�.a.. ce ��'e�✓ s l l�-kbt -'3 l�u 17r. S� �ue�� 9� Zo8 `tzs- 3S'?-9 d�F <br />TENANTNAME CONTACTFOR PERMIT � PHONE <br />I L..a.v�,.� l.��o�,�.�..2 �t2.S - Z`3Fs - L�C�'-7R" <br />CONTRACTOR <br />(� w �..v� <br />PHONE <br />PROPOSED USE OF BUILDING <br />�� C� <br />..- <br />�__. . <br />Building PAechanical <br />PERMIT R Combination R Plumbing <br />TYPE Demolition � Sign <br />Sprinkler <br />ZIP CONTR. LICENSE # <br />Addition HEATSOURCE <br />WORK Alteration �j Electric <br />TYPE New D Gas <br />RepaidMaint. D Other <br />CONTRACT PRICE OF WORK +�_ �� t Z CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WURK DESCRIPTION � <br />t ea.� �� re��e�c� C4e c� S <br />N0. � TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C—AIHANDLING 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 />GAS RANGE <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 AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF INORK 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 APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONT�AEbRS LAW iQAj RCW AND 296.200 WAC. <br />b -3D- d3 <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />