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PERMIT APPLI�A1 ION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-7_57-8857 <br />, SITE ADDRE55 , <br />� <br />_ /�G S�. �.1 <br />'�� LEGA L��. BLOCH <br />DFSC. <br />PARC cL 7AX I.D. p 3��� �'ERM�T a <br />]�'J5/ /.�Uv �n�s d G' , , C- '>; l - �- <br />- iENANT NAMF I CONTACT FOR PERMIT' ' PHONE <br />- — --��� L',�r�a,�,� _ 3��) �s� -v�� <br />CONTRACTOR ADORESS ZIP CONTR. LICE SE <br />�, cx�QrS ��5'�oy <br />PHONE � JA:'�E TTS _�WI�1=�_.___--___.—_._--_— ��5���� /� 0 H`� H <br />PROPOSED USE OF BUILDING �uildiny � Mer.hanical Addllian NEAT SOURCE <br />PERMI7 � Combination Plumhmg IWORR � Alter�urni � Elednr. <br />S�� TYPE � Demolition Siqn TYPE New Gas <br />Sprinkler RepalrlMalnl Olher <br />CONTRACT PRICE OF WORK —�_ CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />WORK DESCRIPTION ` / � <br />�t �� <br />PLUMBING <br />NO. I TVPE OF FI%TUpC OR ITEM <br />WATER CLOSLT (TOILET) <br />BATHTUB <br />/� LAVATORY (WASH BASIN) <br />_�_ SHOWER <br />/ KITCHEN SINK 8 DI�POSAL <br />_/ DISIiWASHFR <br />LAU"JDRY TRAV <br />�_ CLOTHES WASHER <br />URWAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE�BAR/MOPIETC.) <br />OTHER <br />S�� -� ��-� <br />MECHANICAL <br />NO. I TYPE OF FIXTl1RE OR ITEM <br />A/G — NHANULING UNI I S <br />_ f _ FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />� CLOTHES DRYFR <br />�RANG[HOOD <br />WATFR HEATER <br />__ METAL FIREPLACE/STOVE <br />FIRFPLACE INSERT <br />GAS FIREPLACE <br />GAS PANGE <br />� GAS PIPING <br />q EXHAUSTFAN <br />I HEREPV CERITIFY THAT I HAV[ REAU ANU E!(A�11NFD THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT AL� .. <br />PROVISIONS OF LAWS AND ORIOINACES (iOVFRNING THIS TVPE OF WORK WD.L BE COMPUEO WIiH WHETHEft SPECIFIED HEREIN OR <br />NOT. THE GRANTING UF A PERMIi 170ES NOT �RESUMF TO GIVE AUTHURITV TO VIOLATE OR CANCEL THF PROVISION UF ANY OTHEF � <br />STA7E OR LOCAL LAW REGULATING CONSTRUC710N OR THE PERFQRMANCE OF CONSTRUCTION THAT I AM AUTHORIZED BV THE <br />OWNER OP THIS FROPERTV TO PERFORM THE WORH FOR WHICH APPLICATION IS MADE AND I COMPLY WITH TI IE STATE � <br />CONTRAC��lSLAW18271�2CV�AND:96.200Yj'AC. � / <br />�`nzed Ayen� Date / ; , . <br />DEBIT 8 CREDIT CARDS ARE NOT AGCEPTEp /j <br />