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SIT�/ ADDRESS <br />/� LEGAL LOT N0. <br />TENANi'NAME <br />1 <br />P�RiVIIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STRE[T, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />r/ ��w'� <br />BLOCK TRACT <br />A�A <br />�.� S'<�,ra..�c C, <br />PARCEL TAX I.D. # <br />CONTACT FOR PERMIT <br />k� <br />$ <br />%�S =,5 ,�0 -G'.�� �F <br />`s"�"''� � �sE�l?/Z `�a2S=S��G '-C' 33� <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE # <br />PHONE <br />PROPOSED USE OF OUILDING <br />�DD b'.RY-lr �u�ri �-f— <br />�.�4v'Cscc.� <br />CONTRACT PftICE OF WORK <br />WORK DESCRIPTION /-f-�v <br />NO. I TYPC- OF FIXTURE OR ITEM <br />�Q Building Mechanical <br />PERMI7 rj Combination � Plumbing <br />TYPE D Demolition Sign <br />U Sprinkler <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOW ER <br />KITCIiEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRI'TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINI<ING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />I�fZ <br />Addition <br />Alteration <br />New <br />Repair/Maint. <br />HEATSOURCE <br />�Electric <br />Gas <br />Other <br />���� �%.� -� ��I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />COa./�'i `} ,�'-�YO"6�Q�i <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C—AlHANDLING 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 />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND E,YA611NED THIS APPLICATION AND KNOW THE SA�dE TO BE TRUE AND CORRECT. ALL <br />PROVISIONS Of- LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK 1NILL BE COMPLIED INITH WHE'iHER SPEC,IFIED HEREIN'�R <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUM1iE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION GF ANY OTt, <br />STATE OR LOCAL LAW RFGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AP.1 AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRAC'�ORS L4W 18.27 RCW AND 296.200 WAC. <br />,���.....,y��„ ,.a,� � I <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED I2 I <br />