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� PERMIT APPLICATI�N <br />� CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STRtET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />9iTE ADDRESS /QTN Q6�K � I PARCEL TAX I.D. N�O <br />� 9/7 99�` � s� , a�os� � 3�0 �o�s 40- <br />LEGA� LOT y,0. BLOCK <br />DESC. « <br />iJ _ <br />OWNER <br />�Esrrd�r� �,�G' � <br />TENANTNAME <br />CON"RACTOR <br />pHONE ��� <br />PROPOSED USE OF BUILDING <br />`�-�' 1 r� <br />CONTRACT PRICE OF WORK <br />WORK DE9CRIPTION <br />W � <br />NO. I TYPE OF FI%TURE OR ITEM <br />WATER CLOSET (TOILET) <br />- BAiHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />� OISHWASHER <br />LAUNDRYTRAY <br />� CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />fL00R DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICEIBAR/MOPIETC.) <br />OTHFR <br />PERMIT <br />TYPE <br />,� <br />I CONTACTFOR <br />�,� c <br />ADORESS <br />Building � Mechanical <br />Cambination Plumbing <br />Demolition Sign <br />Sprinkler <br />Cc, <br />PHONE <br />ZIP CONTR. LICEN9E / <br />�xA��es � �/°`f <br />��STN �- 98�.7 <br />�Addlllon I HEAT BOURCE <br />Alterallon � Electric <br />New Ges <br />Rapalr/Melnl. Olher <br />CITV OF EVERETT LOCAL 9ALE9 i AX CODE IS J705 <br />NO. i TYPE OF FIXTURE OR ITEAt <br />AIC —FVHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIRFPLACE <br />GASRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />II I HEREBV CcRITIFV THAT I HAVE READ AND E%AMINED THIS APPLICATION AND KNOW THE SAIAE TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF IAWS AND (1RIDINACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIFD WITH WHETHER �PECIFIEL MERE�N OR <br />iNOT. THE GRANTING OF A PEFMIT DOES NOT PRESU1dE TO GIVE AU7HOR'TY TO VIOLATE OR CANCEL TME PROVISIOM OF ANV OTHER <br />STATE OR LOCAI LANJ REGUATING CONSTRUCTION ?R THE PERFORM 1NrE OF CONSTRUCTION. THAT I AM1' AUTHORIZED BY THE <br />OWNER OP T}11S PROPERTV TO PERFORM THE WORK FOR WHICH PPLICATION IS MA�E AND I COMPLY WITH THE STATE <br />CONTRA RS LAW 1 R ANO 29 B NAC '/ <br />� � ��� <br />i pet re o nerlContractor�Aulh nzed Agent ate 1 V., ;/ <br />�Cf% <br />I DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />�- — <br />