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pERMIT APPLICATION <br />CITY OF EVERETT PERMIT SEF2VICES <br />320C CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />RESS �� <br />� �� <br />i nr un 6L•�CK <br />�-�ont <br />TENANTNAME <br />CONTRACTOR <br />PHONE <br />/'Y`Q �!(%/� % <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />PERMIT <br />TYPE <br />( �`/� � C-r��— <br />� I <br />U <br />NO. I TYPE OF FIXTURE OR ITEM <br />� <br />WATER CLOSET (TOILET) <br />BATHTUB <br />IAVATORY (WASH BASIN) <br />SHCWER <br />KITCHEN SINK & DISFOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTA�N <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />PARCEL TAX I.D. # <br />TRACT <br />' � C�l /`7. <br />ICONTACT FOR PERMIT <br />ADDRESS <br />s S�-� <br />�Building Mecnanic <br />Combinalion Plumbing <br />Demolition Sign <br />Sprinkler <br />PERMIT k <br />hno3oq-drl <br />PHONE <br />ziP ��;cTt%59�3 C'r� <br />�, /� 9�� �o GSi' � 90/ <br />n Addition I HEAT SOURCE <br />I--S Alleretion j7 Electnc <br />F_� New � Gas <br />LJ RepaidMaint Other <br />CITY OF EVERETT LOCAL SALES Tnx cwt w s�w <br />NO.. I 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 />R4NGE 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 Or LA'P!S AND ORIDINACES GOVERNING THIS TYPE OF VJORK �VILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />STOATc OR LOCAL'LAW REGUlATING CONS RUCTION OR THE PERFORMANCE OF CONSTRUCTION.CTHAT I AM AOUTHIORI ED BY Olc ER <br />OWNER OF THIS PROPERTY TO PERFORM THE INORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CO JTRACTORS LAW 18.27 RCW AND 296.20� WAC. � <br />��''r�c , �L�. � --i'�.�c% 1.�-�1 _ g—�Q3 <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />