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SITE AUDRESS <br />� C_i � �� <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />y// e ��u• <br />TENANTMAME ' <br />CONTRACTOR <br />PHONE <br />� �, 7�. _k.�t � <br />PROPOSED USE OF BUILDING <br />I�C i� L <br />CONTRACT PRlCE OF WORK <br />WORN DESCRIPTION <br />P�RMIT APPLICATII�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />PARCEL TAX I.D. N <br />� ,,��05�/3.no3c <br />BLOCN TRACT <br />ADDRES$ <br />�G��, I� �A�"i1�/'�/� G <br />J <br />CONTACT FOR PERMIT <br />ADDRES9 <br />B�ilding MechAnical <br />PERMIT Combination PIUrtlbl�g <br />7YPE Demolltion Slgn <br />Sprinkler <br />_�� �'•/�'��, �°� �/�7t�1� <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (1'OILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />�'.OTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />_ BACKFLOW PREVENTER <br />SINK (SERVICEIBAR/MOP/ETC.) <br />OTHER <br />PERMIT N <br />� � o3oCn - <br />21P PHONE <br />9�� � <br />PHONE <br />ZIP CONTR. LICEN9E N <br />Additlon <br />WORK Allerallon <br />TVPE I�ew <br />Rapav�Maint. <br />HEATSOURCE <br />j� ElecVic <br />B Ges <br />Other <br />CITV OF EVERETT LOCAL SALES TAX CODE 19 ]706 <br />OC'/ - L�, � <br />NO. I TYPE OF FIXTURE OR ITEM <br />NC —A/HANDLING UNITS <br />FORCED AIR SVSTEMS <br />HEAT FUMP <br />UNIT HEA7ERS <br />CLOTHES DRVER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACEISTOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />_I GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />I HEREBV CERITIFV THAT I HAVE REAU ANO EXAMWED THIS APPUCATION AND KNOW THE SAME TO BE TRUE AND COFRECT ALL <br />PRPVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TVPE OF WORK WILL AE COMPLIED WITH WHETHER SPECIFIEO HEREIN OR <br />NOT. THE GRANTING OF A PERMIT �OES NOf PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROV1510N OF ANV OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AU7HORIZED B� THE <br />OWNER vF THIS PROPERTV 70 PERFORM THE WORK FOR WHICH APFLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296 200 WAC. <br />5 �3 <br />c:,.....�...e..rn..,..e.�r....�...,.�...in����....�,e� e.,e..� �e <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />