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PE��MIT APPLICATIO�J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 �� �O S_ /� <br />SITE ADDRESS PARCEL TAX I.D. N • PERMiT M /J <br />�>c.%-yS [.i.1;/= I �G�U(if'�"Y�.ic'.�t3c�C I ���5 L�D 6 <br />LOT N0. I BLOCK � TRACT <br />DESC.� � ,j <br />NR�� G��,,�, <br />1/I/f-c..�•le // S�. (j' !.)P ... _1+.� <br />TENANT NAME I CONTACT ''E PHONE <br />;i`'.�.r(- -� rc' -� /`< r`-f fiJ�.� ../ � �- -.).3 L � t'7O <br />CONTRACTOR ADDRESS 21P CONTR. LICENSE N <br />PHONE <br />�-.-i-t'-� <br />PROPOSED USE OF BUILDING <br />PERMIT <br />��„• // TYPE <br />CONTRACT PRICE OF WORK <br />Building <br />Cambinalian <br />Db nolition <br />Spnnkler <br />WORK DESCRIPTION � � �, �� ���` /r r�� <br />/ �y� <br />PLUMBING <br />NO. � TYPE OF FIXTURE OR ITEM <br />WATFH CLOSET <br />�ATfiTUB <br />LAVATORY (W/1Sli �ASIN) <br />SHO�VER <br />KITCHEN SINK 8 DISPOSAL <br />DISfiWASHER <br />LAUNDRYTRAY <br />CLOTH[S WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DHAIN <br />�ACKf'_OW PREVENTER <br />SINK (SERVICE/�AR/MOPIETC.) <br />OTHER __ <br />Mechenical <br />Plum6ing <br />Sign <br />IN e!�/ !�P S ('4' �.f N <br />Addition <br />Alteratlon <br />New <br />RepalrRdnim <br />HEATSOURCE <br />n Eleclnc <br />kOas <br />IJ Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS �105 <br />N0. � TYPE OF FI%TURE OR ITEM <br />y� A/C-A/HANDLWOUNIiS <br />_L FORCED AIR SVSTEMS <br />_� HEAT PUMP <br />C?" UNIT HEATERS <br />� CLOTHES DRYER <br />� RANGE NOOD <br />�WATER HEATER <br />METAL FlFEPIACE/STOVE <br />c FIREPLACE INSERT <br />� GAS FIREPLACE <br />� GAS RANGE <br />� GAS PIPING <br />�_ EXHAUST FAN <br />OTHER <br />I HEPE�Y CERITIFV THAT I HAVE fiEAD AND E%Ah11NE0 THIS APPLICATION AND IWOW 7HE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND OFIDINACES GOVERNING TMIS TYPE OF WORK WILL BE COfAPLIED WI1H WHETHER SPECIFIE� HEREIN OH <br />NOT TH[ GRANTING UF A PERMIT DOES NOT P{iESUME i0 GIVE AUTHORIN TO VIOV+TE OR CANCEI TME PROVISION OF ANY OTHEFl <br />S7ATE OR LOCAL LAW FEGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTR1ICTION. THAT I AM AUTHOR�ZED BV THE <br />OWNER OF THIS PFOPERTV TO PERFOPM THE WOPH FOR WHICH APPLICATION IS MADE FN� I COMPLY WITH THE STATE <br />GONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />''' ( e�7! IYt.K�-c — — .S /�UE� � <br />Signawre of OwnedContractod ulhorized Agent ete <br />