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P��RMIT APPLICATIt�N <br />CITY OF EVERETT PERMIT �ERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />ia�.za� <br />NAME <br />PARCEL TA7( I.D. N <br />?- a.-. 1(. <br />CONTACTFOR <br />PERMIT p <br />�� i:' U���l -v3/ <br />� �fk'E� LN/Wd �CG� �3��� �vS6 -vg'd `f <br />CONTPACTOR ADDRESS 21P CONTR. LICE.I�9E�O� <br />tXP�Q�.S H� <br />PHONE J1^� ��� � (� GgT►� I� 9�ys H <br />PROPOSED U3E OF BUILDIN6 <br />� � � <br />CONTRACT PRICE OF WORK <br />Builrling Mechanical <br />PERMIT � COmbinatiOn � PlUmbing <br />TYPE Demolilion Slgn <br />Sprinklar <br />Aadi�ar I HEATSOURCE <br />Alleratlon � Eledric <br />New Gae <br />Repalr/Malnl Olher <br />CITY OF EVEkETT LOCAL SALES TAX CODE IS 7105 <br />WORKDESCRIPTION �� ��� ���, �'�7_S%C # � '7�� <br />(� J� <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSFT (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KI7CHEN SINK 8 DISPOSAL <br />OISHKASHER <br />LAUNDRVTRAV <br />�LOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />PLOOR DRPIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER _ <br />NO. � TYPE OF FIXTURE OR ITEM <br />A!C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUh1P <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />MET4L FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GASRANGE <br />GA5 pIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBV C�.RITIFv THAT I HAVE READ AND E)(AMMED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVI510��5 OF LAWS AND ORIDINACES GOVERNIN� THIS TYNE OF WORK WILL BE COMPIIED WITH WHETHER SPECIFIED MEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAI. LAW REGULATING CONSTNUCTION OR iHE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNFR OF THIS PROPERTV TO PERFORM iME WORK FOR WHICH APPLICATION IS MADE AND I CUMPLV WITH THE STA'E <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />��L <br />