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PERMIT APPLICATIO <br />CITY OF EVERETT P�RMIT SERVICES <br />3200 CEDf�R STREET, EVERETT, WA D8201 �B9,o7J o2�� <br />425-2E7-8810 - F� �X 425-257-8857 Y�� <br />SITE ADDRESS <br />/Z /Z ' <br />LEGA LOT NO. <br />DESC. <br />OWNER <br />i�NANTNAME <br />CONTF'ACTOR <br />PHONE <br />PROPOSED USE OF BUILDINQ <br />CONTRACT PRICE OF WOHK <br />WORK DESCRIPTION <br />N0, � TYPE OF FlXTURE OR REM <br />SS PARCEL TAl( I.D. • <br />BLOCK TRACT <br />ADOi:ES9 aP <br />ICONTACTNAME <br />ADCRHS i ZIP <br />WATER CL(�SET <br />BATHTUB <br />LAVATORV (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 6 DISPOSAL <br />DISHWASHER <br />LAUNDFiY TRAY <br />CLOTHES WASHER <br />URINAL <br />ORINKING FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICElBAR/MOP/ETC.) <br />OTHER <br />Bullding DMechenicel <br />PERMIT B Combinellon B Plumbing <br />TYPE D Demolitlon Sign <br />D Sprinkler <br />f:L'� <br />PERMIT M <br />PHONE <br />CONTR. UCENSE I <br />n Addition <br />�_� Alteratbn <br />�,.� New <br />L.) Repav/Maml. <br />HEATSnURCE <br />D Eleetr�c <br />g ae, <br />Othar <br />CITY OF EVERETT LOCAL SALE9 TAX COOE 19 9105 <br />TYPE OF fll(TURE OR REM <br />A/C - A/FiANDLINO UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CIOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />OAS FIREPL4CE <br />OAS RANOE <br />GAS PIPIN6 <br />EXHAUSTFAN <br />OTHER <br />I HEREOV CEPITIFV THAT I HAVE R D AND E%AMINED T S AP�LICATION ANO KNOW TME SAME TO BE TRUE AND CORRECT. ALl <br />PROVISIONS OF LAWS AND 0 ID AC S OOVERNING THIS iYF . OF WORK WIIL BE COMPIIED WITM WHETMER SPECIFIED HEREIN OR <br />NOT. THE GRA�NO F R�ES NOT PFESUME TO 61VE AUTHORITY TO VIOUTE OR CANCEL THE PROVISION OF ANY OTMER <br />STATE OR LOC lA I N ONSTRUCTION OR TME PEPFORMANCE OF CONSTRUCTION. THAT I AM AUTHOHIZED BV THE <br />OWNEH OF TH PR P ORM TME WORK FOFi WMICH APPLICATION IS MADE AND I COMPL� WITM THE STATE <br />cONTRACTO U1 298.200 WAC. <br />