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��cRMIT APPLICATIuN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />%��� 3��} - a; �3 <br />/ 425-257-8810 - FAX 425-257-8857 �� 2 �� � �r� <br />i0/a `�` _ � .,� <br />SITE ADDRESS <br />ix',a',;Y✓� —� <br />LOT N0. <br />w', <br />BLOCK TRACT <br />PARCEL TAX I.D. # <br />PERMIT N <br />Oc�, — ? �� — 0/ <br />� ��zr 3 <br />Wex.lc�i.�l `S�jI"�e�e.la;o.tre.✓I',�-%^.c. 3�? �vv i�c,s,F_. �v�=e.� u�iF, �4�a�� <br />TENANTNAME CONTACTNAME PHONE <br />Sc�k�f�� <SC-o ltFo�`ifirn/C� Y.�S �.3d.-6a-i0 <br />CONTRACTOR , ADDRESS � ZIP - CONTR. LICENSE N <br />PHONE Si%tM'L <br />PROPOSED USE OF BUILDING <br />se� l�s/x c. V7oG`te <br />CONTRACT PRICE OF WORK <br />t,� e NOeSQ%/rSH c. <br />� Building n Mechanical , � Addition <br />PERMIT Combination r} Plumbing WORK Alteration <br />TYPE Demolition � Sign TYPE New <br />Sprinkler Repair/Maint. <br />WORK DESCRIPTION N�� �WS r-y,V'�TON <br />�' I ' � I ' I � � .�(1' � <br />" '" PLUMBIP <br />NO. I TYFE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIPJ) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DFAIN <br />BACKFLOW PREVENTER <br />SINK (SEHVICE/BAR/MOP/ETC.) <br />OTHER <br />HEATSOURCE <br />�Electric <br />Gas <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I,fNii L.. CJ�/ � � <br />N0. I TYPE OF FIXTURE pR REM <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 />GASRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />1 HEREBY i;ERITIFY THAT I HAVE READ AND EXAMINED THIS A^PLICATION AND KNO`N THE SAME TO 8E TRUE AND CORFiECT. ALL <br />PROVISIO'JS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIEO WITH WHETHER SPECIFIED HEREIN OR <br />N07. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TG VIOLATE OR CANC':L THE PROVISION OF ANY OTHER <br />STATE OR LOCA� LAW REGULATING CONSTPUCTION OR THE PERPORMANCE OF CONSTRUCTION, IHAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTC'IiS LAW 18.27 RCW AND 296.200 WAC. <br />9�913 <br />�v <br />