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' r�ERiVIlT APPLICA"e �ON <br />CITY OF EVFRETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, V�'A 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITEADDRES$���� _ I�±` IIVF•(�V� �dI(AO�ELT ��D.j <br />l. <br />V" b (l� <br />LEGA LOTNO. I BLOCK I TRACT <br />DESC. <br />TENANT NA�dE <br />CONTRACTOR <br />C. l��i� S�Iv�r,S�r,;x�� IJ� <br />NTA NAME <br />D�(.�Q_ I.�O <br />ADDRESS <br />ar�oHe ��Ci1� <br />PROPOSED USE OF BUIL�ING <br />,S � � . <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />1���� ��r� <br />PLUMBING <br />�O. I TYPE OF FIXTURE OR ITEM <br />� WFTERCLOSET <br />�_ BATF'TUB <br />� L/+Vf,TORY (WASH BASIN) <br />SHOWER <br />I KITCHEN SINK & DISPOSAL <br />� DISHWASHER <br />LAUNDRYTRAY <br />= C�OTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/3AR/MOP/ETC.) <br />OTHER <br />( �' Building Mechanir,al <br />PERMIT r} Combinalion �Plumbing <br />TYPE � Demolition Sign <br />Sprinkler <br />q <br />;( 9�9a (�� <br />ZIP CONTR. LICENSE k <br />C�LDCi�o3�NG <br />�xP. �olaal�3 <br />Addition HEAT SOURCE <br />Alleration Electric <br />New � Gas <br />Repair/Maint. ��� Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />NO. I TYFE OF FIXTURE OR ITEM <br />A/C — A/FIANDLING UNITS <br />FORCEC AIR SYSTEMS <br />HEAT PUMP <br />UNIT HE:ATERS <br />CLOTHE:S �7RYER <br />RANGEHOOG <br />WATER HEATER <br />METAL 1=1REPLACE/STOVE <br />FIRF_PL�10E INSERT <br />GAS FIFIEPLACE <br />GAS RANGE <br />GAS PIF'ING <br />EXHAUl;T FAN <br />�� I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORFECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GGVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />h;OT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />I STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRU�'.TION. THAT I AM AUTHORIZED BY THE <br />� OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADC ANO I COMPLY WITH THE STATE <br />� CONTRI�'�P� LAW 7827 RCW AN0.2°5200 WAC. <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />