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PERMIT APPLICATIOIV <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />4?5-257-8810 — FAX 425•257•885� <br />S�TE ADDRESS I PARCEL TA% I.D.1 <br />�-7 5 �! Si�/ /Jc S'�c� <br />LOT N0. <br />C ' LZ �C C=! 'SC: •• <br />TENANT NAME <br />BLOCK I TRACT <br />ADDRE89 <br />nL'�ivS%: <br />I CONlACTNAME <br />PERMIT I <br />PMONE <br />-OD3 <br />I !'-E�+ �D/�/n.:f U.t. - /�Li) tS c. i c < ��Pu�S�U� � �Y/ <br />CONTRACTOR �-s�-��h,i� � ��� ���G. ADOFESS _ ZIP CONTR. LICENSE M <br />� 9.3 3c iJ ✓Ai ,J r c ti c �IJ'71 �'os3 .�, ��( <br />PHONE (�„��IV��� 7YL+� <br />PROPOSED USE OF BUILDINO <br />S 7��' <br />CONTRACT PRICE OF WORK <br />�`if'� �i-L� rd.._ G� O <br />Building Mechanical <br />PERMI7 � Combinalion R Plumbing <br />TYPE Demolitlon ❑ Slgn <br />Sprinkler <br />3 i i z�t� <br />AOdition <br />AllerOtion <br />ew <br />Rapair/Mein�. <br />HEATSOUHCE <br />n Elactric <br />B Gae <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 310b <br />WORK DE9CRIPi10N <br />/NST.71[i 1�//n[� S!�/Z�..,,�/[c-:�' S �ni .t�l-_;'^-- 1 i`.C' <br />NO. � TYPE OF flXTURE OR REM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWEF <br />KITCHEN SINK 8 DISPOSAL <br />�ISFI�VASHEF <br />LAUNDFV TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKINO FOUNTAIN <br />FLOOR Df1AIN <br />BACKFLOW F'REVENTER <br />SINK (SERVICFIOAR/MOP/ETC.) <br />OTHEF <br />N0. <br />TYPE OF Fl%TUR� OFl ITEM <br />A/C - A/HANDLING lii �ITS <br />FORCED AIR SYSTEMS <br />HEATPUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPIACE INSERT <br />GAS FIREPLACE <br />QAS RANGE <br />GAS PIPINO <br />EXHAUSTFAN <br />OTHER <br />'i.`L'LL'.L' �Nf]j <br />I HEREBV CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND NNOWTHE SAME TO BE TRUE ANO CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES OOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OH <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEI THE PROVISION OF ANY OTHER <br />STATE OR LOCAL lAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTHUCTION. THAT I AM AUTHORIZFO BV THE <br />OWNER OF THIS PROPERTY TO PEFFORM THE WORN FOH WHICH APPLICATION IS MADE AN� I COMPLY WITH THE STATE <br />CONiFACTORS LAW IB.27 RG'�hAND 298.200 WAC. <br />