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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257•8810 — FAX 425-257-8857 <br />SITE ADDRESS <br />-i�- � s <br />L OAL LOT NO. BLOCK <br />DESC. <br />OWNER <br />Dd � / . -D w � �A 11. l /.� / !'r (� �N�i <br />TENANT NAME <br />CONTRACTOR <br />PHONE <br />PROPOSED USE OF Bi11LDIN0 <br />PERMIT <br />TYPE <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION � <br />�lioocQ �.c�/a.c � �n Se.�}' <br />pL S� �-.-•_ f,.. c l.--c� �.ti, a <br />NO. I NPE OF FlXTUFE OR REM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TiiAY <br />CLOTHES WASHER <br />URINAL <br />DRINKINO FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER__ <br />PARCEL TAX I.D.1 <br />TRACT <br />ADDRE38 <br />7/�-9Yt�, �r <br />CONTACT NAME <br />ADDRE35 <br />PEfiM1T N <br />M�uo -o�� <br />�� <br />PhONE <br />CONTR. LICEN9E N <br />Bullding �fMechenical j� AddNbn HEATSOURGE <br />g Combinalion j� Plumbing WORK n Alterelbn (� Electrk <br />BDemolition D Sipn TYPE C� NeW R aee <br />Sprinkler D RepeulMe�n�. U O�her <br />CITY OF EVERETT LOCAL SALES TAIf CODE IS 7105 <br />�r !x in)�v//� .n <br />yrc � /i/1eY �sr <br />�y ic>�dt�,�� �1���j <br />flL Cia ..f. n e y. <br />NO. I TYPE OF FlXTURE OR tTEM <br />A/C — A/HANDLINO UNITS <br />FORCEO AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANOEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />OAS FIREPLACE <br />OAS RANGE <br />�AS PIPINO <br />EXHAUST FAN <br />OTHEH <br />I HERE9V CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND COPRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES 60VERNINO THIS TVPE OF WORK WILL BE COMPLIED WITH WHETNER SPECIFIED HEREIN OR <br />NOT. THE GRANTINO OF A PERMIT DOES NOT PRESUME TO OIVE AUTNORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV OTf/ER <br />STATE OR LOCAL LAW REOULATINa CONSTHUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTflACTORS LAW 1827 RCW AND 298200 jNAC. <br />/Q// �/ d/ <br />