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P�RMIT APPLICATIGnI <br />CITY OF EVERETT PERMIT SERVICES <br />I 3200 CEDAR STREET, EVERETT. WA 98201 <br />; 425-257-8810 - FAX 425-257-8857 <br />I SITE ADDRESS PARCEL TAX LU. # PERMI7 M <br />,�l y�/ ���1� .S� SL� �Mo3 r �- c�l U <br />iLEGAL LOTNO. BLOCK TRACT <br />DESC. <br />/ , ...i��vJu <br />�� � ��/ li� Ii�/✓ _ /os o5 s���( s/ >� ����,�1, u-:, �� xao� <br />TENANT AME I CONTACT FOR PERMIT PHOHE <br />_ ��1 �Itl� 33�1��3bd <br />CONTRACTOR W qS l� i v1 � ICr� AODR SS 15 �] / y S'�7 "- Vr . u t_ 21P CONTR. LICEN9E M <br />WA�r 11r�y��,s,t.,.. 4Y77o <br />PHONE <br />_ (3c��) G+ S �, �,,.� r'� — <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORH <br />WORH DESCRIPTION <br />NO. I TYPE OF FI)fTURE OR ITEM <br />I — <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHF.N SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DR,41N <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOPlETC.) <br />OTHER <br />Building Mechanical <br />PERMIT R Combination � Plumbing <br />TYPE D Demalition Sign <br />U Sprinkler <br />Addill�n <br />WORK Alleralion <br />TYPE New <br />RepairlMainl. <br />HEAT90URCE <br />�ElatMt <br />Gaa <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE 19 ]106 <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C - A/HANDLING UNITS <br />FORCED AIR SY�TEMS <br />HEATPUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER H[ATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAu PIPING <br />EXHAUST FAN <br />OTHER <br />- �+FREBV CERITIFV TH4T I HAVE READ AN� E7fAMINED THIS APPUCATION AND KNOW THE SAME TO BE TRUE AND f,ORRECT, ALL <br />�'�1�)VISIONS OF LAWS AND ORIDINACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED NEREIN OR <br />'n iT iHE GRANTING OFA PERMIT �OES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL TME PROVISION OF ANV OTHER <br />`S"4TE OR LQCAL LAW REGULATING CONSTRUGTION OR THE PcRFORMANCE OF CONSTRUCTION. THA71 AM AUTHORI2ED BV THE <br />�: `�NER OF iH15 PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br />�' 7N7RqCTOR�B 27 RCW AND 296,200 WAC. <br />�J -.S'� �c' S <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />