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'rERMIT APPLICAT�JN <br />CITY OF EVERETT PERMiT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-&857 <br />SITE ADDRESS <br />� I " -18�� f1V <br />LECA LO7 N0. <br />oesc. j <br />OWNER <br />�'n1r�Cre�� In�c. ► <br />TENANTNAME <br />CONTRACTOR <br />PHONE ������� <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />� � �D I�Ltt",� <br />BLOiK I TRACT <br />NO. I NP� OF FIXTURE OR ITEM <br />c�.S�l��e►' <br />VJATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTIiER <br />PARCEL TAX I.D. # <br />Building <br />PERMIT Combination <br />TYPE Demolition <br />Sprinkler <br />�Mechanical <br />Plumbing <br />Sign <br />°��9a <br />ZI P <br />� �� <br />PHONE <br />CONTR. LICENSE # <br />COZOC�-�o ��' NC, <br />�Addilion <br />Alteration <br />New <br />RepaidPAaint. <br />HEATSOURCE <br />�Electric <br />Gas <br />Other <br />CITV OF EVERETT LOCAL SALES TAX CODE IS 3105 <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 />RANGE HOOD <br />WATER HEATER <br />MEfAL FIREPLACE/STOVE <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HERE6Y CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF L4Vi5 AWD ORIGINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIEU WITH WHETHER SPECIFIED HEREIN OR <br />FJGT. THE GRANTING OF A PERDAIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOfATE OR CANCEL THE PflOVISION OF ANY OTHER <br />STHTE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />O`NNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS iY1ADE AND I COMPLY WITH THE STATE <br />COP!?RAGTUA LAW 1.27 RCW AND 296.200 WAC. <br />%� ��1� %�y��'3 <br />..��� ,.,_... -- � <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED � 3 <br />