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�ERMIT AC�PLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />� 425-257-8H10 - FAX 425-257-8857 <br />— —� <br />F=� �� <br />���• SITE �1DDRESS PARCEL TAX I.D. # PERMiT x <br />,� i`� `I bL- 1/ l4l/L S �-- I�C O 3i I,Ov-5 _ <br />� �EGA� W ( NO. BLOCK�TRACT <br />DESc.I <br />OWNER ADDRESS ZI� PMONE <br />I S �..� n a 9I 9 -�o� +Eti ►��e < <.,� �'�e _ <br />, 'T7ENANTNAME CONTACTFOR PERMIT \l PHONE <br />;_�'�'��'�_S � I I�oP�-9�r 7 S��j - 5l �� _ee ` <br />i CONTRACTOR <br />� PHONE S l�C? �� � I .' � � �-��.) <br />PROPOSED USF. OF BUILDING <br />COrITRACT PRICE OF WORK <br />�WORH OESCRIPTION <br />PLUMBING <br />NO. I TYPE Of FIXTURE OR 17EM <br />C_ WATER CLOSE7�TOILET) <br />BATHTUB <br />�. LAVATORY (WASH BASIN� <br />� -- <br />SHUWER <br />�_ KITCHEN SINK 8 DISPLSAL <br />_ DISHWASHER <br />LAU��RY TRAY <br />CLOTHCS WASHER <br />�: URINAL <br />r DRINKING FOUNTAIN <br />!� _ FLOOR DRAiN <br />BACKFLOW PREVENTER <br />) _ S�NK (SERVICE'BARiMOPIETC.) <br />_ OTHER <br />AUQRESS <br />ZIP CONTR. LICENSE K <br />- --- � U S�CU �Y , I o m� <br />Auilding ��] M�or.hanical Addition HEAT SOURCE i <br />PERMIT R Combination,�J"Plumbing IWORK � Altnralion I Ii Flectnc � <br />TVPE n Oemolillon L�gn TYPE New �_� Gas I <br />C� Sprinklar Repa�nMainl. lJ Other . <br />CITY O� EVERETT LOCAL SALE9 TAX CODE IS 7106 <br />NO. I TYPE OF FIXTURE OR ITEM <br />�-� <br />A/C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />bVATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />�MS PIPING <br />EXHAUSTFAN <br />OTHER _ _ <br />�Fi2EBV CERITIFV THAT i HAVE READ AND EhAMINEO TNIS A?PLICA?ION AND KNOW THE SAME Tq BE TRUE AND CORF<ECT ALL <br />�"�:V�SIOiJS OF LAWS AND ORIDINACES G0�/ERNING THIS TYPE OF WORK WILL E1E COMPLIED WITH WHETHER SPECIFIF.D HEREIN OR <br />.� ' T�iE G4ANTING OF A PERM1IIT pOES NOT PRESUME TO GIVE �UTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />�"A1 E OR LOCAL LAW REGULATING CONSTRUCTION OR TNE PERFORMANCE OF CONSTRUCTION. THAT I AM A' 1THOFIZED BV THE <br />C NNF4 O,F'HIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MA�E AND I l J�1PLV WITH THE STATE <br />�',)�N{rR�./}�,,(ORS LA '�/'/y� 17 RC'N AND 2?fi 200 WAC. <br />!^.4Y!��// iZ�� <br />DEBIT 8 CRE�IT CAROS ARE NOT ACCEPTED <br />