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ERMIT APPLICAT <br />CITY OF EVERETT PERMIT SERVICES <br />320U CEDAR STREFT, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8A57 <br />SITE ADDRESS � <br />23� I �2' S� <br />LEGA L07HO.nc LdC' BLOCK <br />TRACT <br />PARCEL TAX I.D. # <br />J <br />� • <br />�� • <br />TENANT NAME CONTACT FOR PERMIT � PHONE <br />�cvv= I �jE�E ����O�c �aL-23Z-?i� I <br />CONTRACTOR •�� �.r-�,� ��`� ADDRESS 21P CONTR. LICENSE il <br />{ t-- ,.�p <br />PHONE ?��\ G ��2� _`�� <br />�,. l2� ���,�t �, k�iL��l <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />Building Mechanlcal <br />PERMIT �ombination � Plumbing <br />TVPE emolitlon U Slgn <br />Sprinkler <br />WORKDESCRIP'.ION pF_��` �� ����`�6 <br />1- <br />PLUM8ING <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATH1'UB <br />LAVATOFY (WASH BASIN) <br />SHOWC-R <br />KITCHEN SINK 8 DISPOSAL <br />DI;iHWASHER <br />LAUNDRYTRAY <br />CLOTMES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACYFLOW PREVENTER <br />SINK (SERVICE/BARIMOPIETC.) <br />OTHER _ <br />WORK R <br />TYPE D <br />D <br />Addit�o�i ( HEATSOURCE <br />Alteretlon � ElecUlc <br />New Ges <br />Repair/Malnt Other <br />CITV OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />�:«M �JL— <br />N0. I TYPE OF FI%TURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />� I HERE9V CERITIFY THAT I HAVE READ AND EXAMINED 7HIS APPLICATION AND KNCIN THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS T'PE OF WORK WILI. BE CnMPLIED �VITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO C71VE AUTHORITV TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHER <br />- STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMAP. ;E OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />� OWNER OF THIS PROPERTY TC� PERFORM THE WOFiN FOR WHICH APPLICA'ION I�S MADE AN� I COMPLV WITH THE STATE <br />I CONTRACTpHS V+W J827 RaIN �(�!D 296200 WAC. / / <br />DEBIT 8 CREDIT CARDS ARE hvT ACCEPTED <br />