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SITE ADDRESS <br />LOT NO. <br />TENANTNAME <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />n r, j425-257-8810 — FAX 425-257-8857 <br />BLOCK <br />PARCEL TAX I.D. # <br />CONTACT FOR PERMIT <br />PERMIT # <br />�%J-c/ -. <br />PHONE <br />CONTRACTOR ADDRESS <br />PHONE yT/N� Cv' 6 F�$� ��� ! ����Z CONTR. LICENSE # <br />O $' <br />PROPOSED USE OF BUILDING <br />PERMIT <br />Building ��Mechanical <br />Combination r) Plumbing <br />WORK RRAddition <br />HEAT SOURCE <br />leclric <br />TYPE <br />,I <br />Demolition Sign <br />II-�All-era <br />11 <br />TYPE 9`New <br />I) Gas <br />Sprinkler <br />UU Repair/Maint. <br />Other <br />CONTRACT PRICE OF WORK O <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WnaK nFcrc!cnnu <br />i'� S %f3LL !�� N��T PUi/� Sf�SiEi�L G✓/ T%LG % L./a,�` <br />NO. I 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. I TYPE OF FIXTURE OR ITEM <br />W1 <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <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 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 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 APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />/L —&i <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />U10 <br />