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SITE ADDRESS <br />LOT <br />DESC <br />�ERMIT APPLICA�idN <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. N <br />I� <br />a,v�, l D- pc�0 <br />PERMIT N <br />�3/v—�i�.l <br />�TENANTNAME CONTACTFORPERMR� ' PHONE <br />I �r,�c� L',v�,cc,e (a��) �sa -v�d �f _ <br />CONTRACTOR �.ODRESS 21P CONTR.LICE_I���f1 � <br />�x�ia,�-S HI lo <br />PHONE Jf�ME TTv ��C � (�C.�Ty {� q�NT H <br />PROPOSED USE OF BUILUING <br />S �k' <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPiION /J/ �� <br />/(/f <br />NO. I TYPE OF F�%TURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAV <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLVOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICElBARlMOP/ETC.) <br />OTHER_ <br />PERMIT � <br />TYPE <br />Building Mechenlcal <br />Combinatlon � Plumbing <br />�emalition Sign <br />Sprinkler <br />Addillon HEAT SOURCE <br />WORK Alterallon � Electdc <br />TVPE Naw Gas <br />RepairlMainl Olher <br />CIT! OF EVERETT LOCAL SALES TAX CODE IS 3709 <br />✓ � �T <br />NJ. I n'PE OF FIXTURE OR ITEM <br />A/C — AIHANDLING UNITS <br />� FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />1_ CLOTHES DRYER <br />�RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE IN5ERT <br />�GAS FIREPLACE <br />GAS RANGE <br />,� GAS PIPING <br />�, EXHAUST FAN <br />OTHER <br />I HEREBV CERITIFY TNAT I NAVE READ AND ExAMINEO THIS APPIICATION APlD HNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES (;OVERNING TNIS TVPE OF WORK WILI BE COMPIIED WI7H WHE?HER SPECIFIEO HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOi PRESUAIE TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANV OTHER <br />STATE OR LOCAL lAW RF.GULATING CONSTRUCTION OR iHE PERFORMANCE OF CONSTRUCTION. iHAT I AM AUTHORIZED BV THE <br />P� JER OF iH . PROPERT. V TO PERFORM THE WORK FOR WHICH APPLICA?ION IS MADE AND I COMPLY WITH THE STATE <br />1CCEPTED <br />��L <br />