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�t�MIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADD^�SS <br />Z�ao //f���/�L aE <br />LEGA LOT N0. BLOCK <br />DESC. �� 7 <br />A/ 1C�Yr' i <br />TENANTNAME <br />CONTRACTOR <br />PHONE � <br />PARCEL TAX I.C. # P MiT p �{� <br />� - -- <br />ii:LPil <br />�����s,[i/ !�/a'O //P��P` SC �ve.r.��wA �'`�� �1� 357-0990 <br />PROPOSED USE OF BUIIUING <br />5�72� <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />CONTACT FOR PERMIT <br />f�l �+l.Y/"..��N <br />ADDRE59 <br />Building Mechanical <br />PERMIT R Combinalion R Plumbing <br />TYPE Demolilion � Sign <br />Sprinkler <br />-J�� � GJ�•�(.�c�'--� /'�- �.Cu1L(_�I�� <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />IAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPnSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />PMONE <br />y1 S 31i 3- S�3.� <br />21P CONTFt. LICENSE M <br />j� Additian <br />r--1 Alteration <br />K New <br />V Repair/Maint. <br />HEATSOURCE <br />Eleclnc <br />Gas <br />Olher <br />CITY OF EVERETT LOCAL SALES TA% CODE IS �105 <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C — A/HANDLING 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 FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />I HEREBV CERITIFY THAT I HAVE READ AND EXAMINED THIS APPL�CATION AND KNOW THE SAME TO 0E TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TVPE OF WORK WILL Bf: COMPLIED WITH WNETHER SPECIFIED HEREIN OR <br />NOT. 7HE GRANTING OF A PERMIi DOES NOT PRESUAIE TO GIVE AUTHORITV TO VIOIATE OR CANCEL THE PROVISION OF ANV OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUC710N OR TNE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PR PERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRArTORS L�'IB27 RCW AND 296.200 WAC. <br />, , <br />�'�- i(• J3 <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />