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�'ERMIT APPLICAI �ON <br />. CITY OF EVERETT PERMIT SERVICES <br />3200 CE�AR STREET, FVERETT, 1NA 982C1 <br />' 425-257-8810 - F�,X 425-257-E3857 <br />,� SITE ADDRESS <br />LOT <br />IlFSC. <br />Y� c, .� <br />BLOCN <br />PARCEL TAX I.D. p 3�'�� � <br />__�A�Y _(>3DU��;�_G�U <br />I nEPM1T a � <br />'�_�_���:i/-��� ) <br />� �._l,��.r.�� ��,t-,�.: .�ZU�11U- a,-. a.lu_��� �✓c 1_t,�� "� '.��5_d�►3� <br />iTFNANTNAME I CONTACTFORPERMIT PHONE i <br />� <br />I -- ---- _��'�y__�N�.v_a,cy�---- ,�d�� �so_��v �f ; <br />iCONTRACTOR AOORESS <br />� ZIP CON'R. LICE SE I <br />PHONE � tX{�IIZIe'S 11�Y�O.1 I <br />��A� �,s C�,,�n (�CST���. ��ySH I <br />PROPOSED USE OF BUILDING budding � Mer,hanical Addlllon HEA7 SOURCE i <br />I PERMI7 CornbinBtiun � plUmbiny WORK � Alterahon EleUric <br />^` TY^E �I Demolilion Siyn TVpE NeW � �ay � <br />J�/� _ --- l Sprinkl�r RepaidMaint I Olher , <br />CONTRACT PRICE OF WORK � CITY OF EVERETf LOCAL SALES TAX CO ' <br />I WORK OESCRIPTION <br />/�,E�i.� d���� -f,�'o71,' <br />NO. � TYPE OF FIXTURE OR ITFM <br />WATER CLOSFT (T01L: T) <br />BATHTUB <br />LAVATORY (WASH BAS�N) <br />� SHOWFR <br />KITCHEN SINK S DISPO:iAL <br />/ DISHWASHER <br />LAUNDRYTRAY <br />� CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />_ fLOOR DRAIN <br />_ BACKFLOW PREVENTER <br />_ SINK (SERVICElBAR/MOP/ETC.) <br />'�c � ,�,�.�/ <br />"'1. I TYPE OF FIXTURE OR ITEM <br />fvc - �vc inNULING UNITS <br />_(_ FORCED AIR SYSTEMS <br />__ HE4f PUMP <br />UNIT HEATERS <br />_.L CLOTHES DRYER <br />�RANGFHOOQ <br />WAT[R IiEATER <br />M[TAL f'REPLACE/STOVE <br />FIREPLAt;[ INSERT <br />T GAS FIREPLACE <br />� GASRANGE <br />�GAS PIPING <br />EkHAUSTFAN <br />OTHER <br />—I — <br />OE IS 7705 <br />� HEREBV CEIiITIFY THAT I HAVE READ ANU E.tAMINEU iHIS APPLICATION AND KNOW THE SAA1E TO BE TRUE AND CORRECT ALL <br />PROVISIONS OP LAWS AND ORI�INACES GOVERNING iH15 T\'PF OF WORK WILL BE COMPLIED W11H WHETHER SPEC:FIED HEREiN OR <br />NOT THE GRAN7ING OF A PERMIT UOES NOT PRESUM11E TO GIVE AUf HORITY TO VIOIATE OR CANCEL TFiE PROVISION OF A�JV pTHER <br />STATE OR L�)CAL LAW RE�3ULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRI�CTION 7h;471 qM AUTHURI2ED Bv THE <br />OWNFR pF THIS PROPFRTV YO PFFFORM THE W�7qK FOR WHICH APPLICATION IS MADE AND I COMPLV WITH 7HE STATE <br />CONTRACTQRS LAW 192�1'JW9WU 296 200 WqC � � <br />i i i i <br />A <br />L�� <br />DEBIT & CRE�IT CARDS ARE NOT ACCEPTED <br />I <br />