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SITE ADDRE55 <br />.')-�� - 9 �`j"h <br />LEGA LOT N0. <br />DESC. <br />A <br />�-ERMIT APPLICATiJN <br />CITY OF FVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 9A201 <br />425-257-8810 - FAX 425-257-8857 <br />BLOCK <br />V�ll\Gn \ <br />Wi��iqc� �, ��krc�n <br />TENANTNAME <br />. � <br />CONTRACTOR <br />PHGNE <br />PROPOSED USE OF BUILDIPIG <br />CONTRACT PRICE OF WORK <br />WORK DESCRIP110N <br />NO. I TYPE OF FI%TURE OR ITEM <br />� <br />WATER CLGSET (TOILEi) <br />BATHTUB <br />. AVATORY (WASH BASIN) <br />SHOW ER <br />K�TCHEN SINK 8 DISPOSAL <br />DISHWASHE� <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SEkVICE.�BAR/MOPIETC.) <br />OTHER <br />PARCEL TAX I.D. # <br />TRACT <br />�aa �����-fir� �t <br />CONTACT FOR PERMIT <br />ADDRESS <br />PERMIT N <br />Mo31 I-� <br />ZIP PHONE <br />' 1�da3 Cy�� -��-os�o <br />PHONE <br />21P CONTR. LICENSE ll <br />j� Building Me�hanical <br />P[RMIT [� Combination � Plumbing <br />TYPE D Demolitian Sign <br />U Sprinkler <br />�Adaltion <br />Alterallon <br />New <br />Repair/Maint. <br />HEATSOURCE <br />(7 Electric <br />� � Gas <br />LJ Ulhe� <br />CITY OF EVERETT LOCAL SALES TA7C GOOe is aius <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHESDRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />'� FIREPLACEINSERT <br />GAS FIREPLl�CE <br />GAS RANGE <br />� GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFV THAT I HAVE REAU AND EXAM1IINED THIS APPLICATION AND HNOW THE SAME TO BE TRUE AND CORRtCT. ALL <br />PFCVISIONS OF L4WS ANU ORIDINACES GOVERNING TNiS TYPE OF WORK WILL �E COMPLIE� WITH N'HETHER SPECIFIED HEREIN OR <br />NOT. 'HE GRANTING OF A PERIdIT DOES NOT PHESUME TO GNE AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />nw �FR OF OHIS PROPERTY OTPEF ORM11 THE WORKOFOR WHICH PPL'ICAT ONFS MADE A� DTIOCOMP Y WAH THE 3 ATE D BV THE <br />�3 <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />