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PE�RMIT APPLICATIC�i�1 <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, FVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS �// �„� <br />7I .�J�" _ril,,i'( <br />LEGA LOT NO. <br />DESC. SE.�C i v� � <br />OWNER <br />�_,� <br />( /� 1� J�� <br />TENANT NA E <br />CONTRACTOR <br />PHONE <br />PROPOSED USE OF BUILDING <br />'' (_' <br />% ;,�r l <br />V �% (�/� <br />. <br />CONTRACT PRICE OF WORK 7l <br />�.. <br />WORK DESCRIPTION <br />t���(/iI��I1 v%!r� <br />J <br />NO. I TYPE OF FiXTURE OR ITEM <br />�J <br />BLOCK <br />11 <br />PARCEL TAX I.D. # <br />aa0.5'3o�03d ii0a <br />ur <br />(� --3.� �',u, f �%` �� D/ <br />CONTACT FOR PERMII <br />widin{� D Mechanical <br />PERMIT Combination U Plumbing <br />TYPE Demalition U Sign <br />Sprinkle�r <br />> ( �� <br />. �� <br />1 �X _ l:?-�" <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHeN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />r�zs-,zsq -sa od- <br />PHONE <br />� S9-sa o,s <br />ZIP CONTR. LICENSF S <br />Addition HEAT SOURCE <br />Allera0on Electric <br />New � Gas <br />Repair/Maint. I� Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />NO. . � 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 />R,4NGE HOOD <br />WATER HEATER <br />METAL FIREPIACE/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 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 PE�°ORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICN APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACT„�1j2S LAW 18.27'RCW AND 296.200 NJAC. <br />DEBIT & CREDIT CARDS ARE NO'T ACCEPTED <br />� <br />