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PERMIT APPLICATIOf�� <br />CITY OF tVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, �NA 9820? <br />425-257•8810 — FAX 425-257-8857 P <br />— (� <br />SITE ADDRESS <br />�1 �02- 21 �'��� <br />LOT NO. <br />� <br />CON7RACTOR L.EqQC�' <br />�1 <br />PROPOSEO USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />VYORK �ESCRIPTION <br />SF � ��C1�1 �� <br />P�uMeir <br />NO. I TYPE OF FIXTURE OR ITEM <br />I �_ <br />PARCEL TAX I.D. H <br />2 <br />BLOCK TRACT <br />PERMIT <br />/• � <br />� c�o.� <br />i2o2-�-oz <br />AD�RESS ZIP PHONE <br />lill� S.I��.S4PVPv�S S�G{ f�'ZOC <br />a�P�,r���:Wq Rq`;s;s y'LS;�yC�s73 <br />CONTACT NAME PHONE <br />eSNUi�r�CaoDREss I`�i5lloj.Lk( j'tev <br />`>4E',ZlJU <br />La'Fie S1-Evev�S,�ti � <br />bVATER CLOSET � j � <br />BATHTUB �j <br />LAVATOP,'/ (WASH BASIN) I � � � <br />SHOWER � <br />KITCHEN S�NK 8 DISPOSAL <br />DISHVJASHER <br />LAUNDRYTPAY <br />CLOTHES WASHER <br />URINAL <br />DFINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKF�OW PREVENTEF <br />SINK (SERVICEiBAP/MOP/ETC.) <br />OTHER <br />PERh11T <br />TYPE <br />Building Mechanical <br />Combination R Plumbing <br />Demolition � Sign <br />Sprinkler <br />21P <br />�l 5Z5�' <br />C.ONTR. LICENSE q <br />LtC,A �'FINo 4 U le !�, <br />Adtlition HEATSOUFCE <br />WORK R Alteration �Eler.tric <br />TYPE ��� New Gas <br />a Repair/PdainL Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />G .r,=-_.c:= <br />NO. � TYPE OF FIXTURE OR ITEM <br />a/C: — A/HANDLING UNI7S <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATEHS <br />CLOTHES DRYER <br />RANGEHOOD <br />LVATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPIACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN %I ) I <br />OTHEFi � <br />:-!EnEBY CE'nITIFY', HAT I HAVE READ AND EXAM1tINED THIS �PPLICATION AND KNOW THE SAME TO 8E TRUE ANO CORRECT. ALL <br />=.�+OVISIO�V� OF U'.VS APlD ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED'NITH WHETHER SFECIFIED HEFEIN OR <br />�JOT. THE GRAN�i ING OF A PEAMIT DOES NOT PP.ESUME TO uIVE AUTHORITY TO VIOUITE OR CANCEL TNE PROVISION OF ANY C7HER <br />.TATE Oi7 IOCA� LA�PJ REGU�4TING CON57RUCTION OF THE PERFORMANCE OF CONSTFUCTION. THAT I AM AUTHORIZED BY THe <br />`.N1NER OF THIS ?ROPERTY TO PERFOFh1 THE'NOFK FOF WHICH APPLICATION IS �dADE AND I COMPLY WITH THE STATE <br />�NTR�CTOP51 i�'(B,I:I/����1?i/6�00WAC. �/I I.CLY��/ <br />�J <br />i� <br />z <br />