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S�TE ADDRESS <br />LEGAL I.OTD <br />DESC. — <br />OWNER <br />%� -�NE <br />TENANTNAME <br />:�ONTRAGTOR <br />r'ERMIT APPLICA'� ION <br />CITY OF EVERETT PERMIT �ERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />BLOLK <br />PHONE � <br />-��Nce. �.s C�,:� � <br />PROPOSED USE O� BUILDING <br />_� <br />CONTRACi PHICE OF WORK <br />PARCEL TAX I.D. N <br />CONTACTFOR <br />ADDRESS <br />Building Mechanical <br />PERMIT � Combination � Plumbing <br />TYPE �emolillon Sign <br />Sprinkler <br />WORK DFoCRIPTION �' '7 <br />/�'�t�J �- <br />NO. I TVPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />l_AVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISFOSAL <br />DISHWASNER <br />LAUNDRYTRAY <br />CLOTFIES WASHER <br />URINA� <br />�RINKING FOUNTAIN <br />FLC�R DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />GG y <br />.,cc L�G <br />TYPE <br />D�� ��� - v�� <br />PERMIT M <br />„ D3/ � ��O�i <br />PHONE <br />3��) �s6-v�d �f <br />ZIP CONTR.LICE.���1 � <br />cxp�Q,�s H lo <br />(�G.�TI� �. 4 �HS H <br />�A ldlllon I HEAT 90URCE <br />Altera'bn j� Elactric <br />New � Gas <br />Repalr/Meint a Olher <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 7705 <br />AS/C� � o?,��� <br />NO. ( TYPE OF FIXTURE OR ITEM <br />A/C – Alr1l�NOLING UNITS <br />� FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />� CLOTHES DRVER <br />�RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACElSTOVE <br />FIREPI ACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />,� GAS PIPING <br />� EXHAUSTFAN <br />OTH[R <br />I HEREBV f.ERITIFV THAT I HAVE REAU AND EXAMWED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORIDINACES GCVERNING THIS 7VPE OF WORK WILL BE COMPUED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. 7!;� �RAN7ING UF A PERh11T DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISWN OF ANY OTHER <br />STATF. OR LOCAL LAW REGULl�TING CONSTRUCTION OR THF PERFORMANCE OF CONSTRUCTION THAT I AM AUTHORIZED BV THE <br />OWNER OFTj��IS PROPERTV TU PERFORM THE WORK FOF WHICH APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACi3J�s5 LAW 18.27 RCWAND 296.2D01^MC / � <br />inzea Hyern uaie �--, � <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED /2 <br />