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S�TE ADDRESS <br />iuSi:[.a <br />TENANTNAME <br />NERMIT APPLICAT �ON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />BLOCK <br />PARCEL TAX I.D. p <br />CONTACTFOR <br />PERMI i M <br />aG C�3��- pi <br />PHONE <br />� �r,�c4 L'Nr�a,r.�,e (3��j �s6-v�d �� <br />CONTRACTOR ADDRESS ZIP CONTR.LICE_I���11 �� <br />CX{>IQie.`� li� �0 <br />PHONE ,A�� � %� � � <br />�...�.�:, <br />PROPOSED USE OF BJILOING � <br />I PERMIT <br />� TYPE <br />� <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION A �� ��}'�� <br />/U�� '� a <br />NO. I TVPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWFR <br />KITCHEN SINK 8 DISPOSAL <br />DISHW�SHER <br />LAUNDRY TRAY <br />CLO7HES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP�ETC.) <br />OT� iER_ _ <br />Building <br />Combinatlon <br />Demolition <br />Sptlnkler <br />�Mechanical <br />Plumbing <br />Sign <br />. 9 �Hs H <br />Addlllon HEAT SOURCE <br />Altera�lon Eledtic <br />New Gas <br />Repalr/Maint. Olher <br />CITV OF EVERETT LOCAL SALES TAX CODE IS J10S <br />����� <br />MECHA� <br />NO. I TVPE OF FIXTURE OR ITEM <br />A/C - A/HANDLING UNITS <br />FORCEL� AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATFRS <br />CLOTHES DRYER <br />RANGE HOOD <br />N�ATER HF.ATER <br />METAL FIPoEPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />G�S RFiNGE <br />GAS PIPING <br />EXHAl1ST FAN <br />OTHER <br />i HERE[lY f,ERITIfV THAT I HAVE READ AND EkAMINED THIS APnLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIUJS OF LAWS AND ORIDINACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT THE GRAN7ING OF A PERMIT DOES NOT PRESUME i0 GIVE AUTNORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGU!.J�TING CONSTRUCTION OR THE PERFORMANCE OP CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OFs HIS PROPERTY TO PERFORM TNE WOk1C FOR WHICH APPLIi.AiION IS MADE AND I COMPLY WITH THE STATE <br />,,,..._...,.✓ .,.. , .... ... .... ....... ..�.. .,.� .,,.. ,.,... <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />