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�PERMIT APPLICAI ION <br />CITY OF EVERETl' PERMIT SEF2VICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADURESS <br />2� / 5�i-, <br />LEGA l0T N0. � BLOCK <br />DESC. '�` . � <br />PARCEL TAX I.D. p <br />12G2 -1 !� DD <br />� <br />57Fv��l JOh�i1� ,Lq�(!05'�/C,�/L C.�nS�. ,Se/�cl�D/Z <br />TENANT NAME CONTACT fOR PERMIT PHONE <br />s��,� rq�s�7s�-zo> z <br />CONTRACTOR ADDRESS ZIP CONTR. IICENSE N <br />STF_ t: S,TLO , ,Ci< <br />PN�iNEL1�/�%/� �S <br />J f �, <br />PROCOSED USE OF BUILUING <br />CONTRACT PRICE OF WORK — <br />WORK OESCRIPTION <br />�� �� � <br />NO. I TYPE OF FI%TURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KII�CHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRI�TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAIZ'MOP/ETC.) <br />OTHER <br />Buildin� f'i Mechanical a��dltlon I HEAT SOURCE <br />PERMIT R{-( Combination H Plumbing WORK A�terauon yn.( Electnc <br />TYPE �..j Demolilion V Sign TVPE New ,/� Gas <br />U Sprinkler R�pair/Maint. l.� Other <br />/J .� ��� CITY OF EVERETT LOCAL SqLE3 TA7( COUE IS 9705 <br />� , <br />��� 225� <br />MECHANICAL <br />NO. I TVPE OF FIXTURE OR ITEM <br />A/C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES ORYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLAr,E <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER__ <br />I HEREOY CERITIFV THAT I HAVE READ AND EXAMWE� THIS APPUCATION AND KNOW THE SAML TO BE TRUE AND CORRECT. AL� <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK 4VILL BE COMPLIED WITH 4YHETHER SPECIFIED HEREIN OR <br />NOT THE GRANTING OF A PERh11T DOES NOT PRESUME TO GIVE AUTHORITV TO VIOIATE OR CANCEL THE PROVISION OF ANV OTHER <br />STATE OR LOCAI LAW REGULA'jING CONSTRUC'ION OR THE PERFORMANCE OF CONSTRUCTION. T��A1 PM AUTHCRIZED BY T�1E <br />OWNER OF T PROPERTV��rv5 PERf� RM 7HE WORK FOR WHICH APPLICATION IS MADE AND I COMPLV n�iTH THE STATE <br />CONTRACfO S IAW 1827 jlGW AN� 296.�0 WAC. , <br />' 1S` c! <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />