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P :RMIT APPLICATI� N <br />CITY OF EV�RETT PERMIT SERVICES <br />�' 3200 CEDAR S'TREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />�iIM f,�' G�ZI -(�y"fl��e.l�/ <br />SITE ADDRESS PARCEL TAX I.D. N PERMiT n <br />9�Z ( � (� - m �` ��� .� �. <br />oa� ti rr ..i / � .L <br />BLOCK I TRACT <br />�� <br />CONTRACTOR 'I <br />�`���— CJS�C`µ'` ry��tONiCS <br />PHONE <br />A-7C �l "7_Ci/S�it <br />PROPOSE� USE C)F BUII_DING <br />CONTRACT PflICE OF WORK �0/„ <br />u� <br />WORK DESCRIPTION <br />. �S�`�( <br />� �.� � � <br />NO. <br />� <br />CONTACT <br />f,O�Z�O ��c_t� �� <br />Building Mecl <br />PERMIT � Combination Plun <br />TYPE Demolilian Sign <br />Sprinkler <br />PHOME <br />ZIP CON�/TR. LICENSE W <br />gFj20'4 Fi�l IL'CLIiODC)�I!q <br />Additian <br />WORK Alteralion <br />TYPE New <br />Repair/PdaiN. <br />HEAT SOURCE <br />Electric <br />Gas <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />�� 5 f�� � W�1 i G� Q� �t � � U-7 G S � i�� <br />ING <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KI I'CHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LA�'NDRY TA.4Y <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKF�OW PREVENTER <br />SINK (SERVICElBAR/MOP/ETC.) <br />OTHER <br />N0. I TYPE OF PIXTUPE OR ITEM <br />� <br />A/C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DFYER <br />RANuEH00D <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERI i IFY THAT I HAVE FEAD AND EXAMINED THIS APPLICATION AND KNOW Th1E SAM11E TO BE TFiUE AND CORRECT. ALL <br />PROVISIONS OF �S AND ORIDINACES GOVERNING THIS TVPE OF WORK WILL BE CCMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRAN i G OF A PERtv11T DOES NOT PRESUME TO GIVE AUTHORITY TO VIOL4TE OF CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LO� CLAW FEGULATIN CONSTFUCTION OP THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZE� 8Y THE <br />OWNER OF�7 IS PROPERTY TO RFORM THE WORK OF WHICH hPPLICATION IS hiADE AND I COMPLY WITH THF. STATE <br />CONTRAGT�LAW 18.27 RC AND 296.200 WAC. � <br />rj � O S U�L <br />