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�NERMIT APPLICAI �ON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SIT ADD �SS �+� �� ��� ` <br />� 5 - , �1 -.� <br />IF�A LOTNO. BLOCK TRACT <br />DESC. <br />PARCEL TAX I.D. p <br />PERMIT # <br />�; N-4,�Q �c.,n�c� � Sl.evn Grc�� °�s-� �{�-4f �,J R�e.�a�! q Fs�o3 <br />TENANTNAME <br />CONTRACTOR <br />PHONE �\ � <br />V <br />CONTACT FOR PERMIT <br />PHONE <br />�� E� �� � �' l � ZIP� ^ CONTR. LICENSE p <br />kJ Q ��i3 <br />PROPOSED USE OF BUIL�ING Building Ii Mechanical I Aaditlon I HEAT SOURCE <br />PERMIT R Com6ination I—'i Plumbing WORK R Alterellon li Electric <br />I TYPE g Demolitlon D Sign TYPE g New g Gas <br />Sprinkler Repalr/Malnl. Other <br />CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />WORK DESCRIPTION <br />NO. � TYPE UF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOi)R DRAIN <br />BAChFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />MECHANICAL <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 />R4NGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />'i I HEREBY CERITIFV THAT I HAVE READ AND EXAfdINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />� PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPt OF WORK WILL BE CUMPLIED WITH WHETHER SPECIFIED MEREIN OR <br />''� NOT, THE GRANTING OF A PERAIIT DOES NOT PRESl1ME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />li STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TME PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />' OWNER OF TNIS PROPERTV TO PERFORM THE WORK FOR WHICH v,PPLICATION IS MADE AND I COMPLY WITH THE STATE <br />I CONTRACTORS LAW iB.27 RCW AND 296200 WAC. <br />ISignalure of OwnedContractorlAuthonzed Agent Date /Z <br />� _ DEB�T & CRL: .;ARDS ARE NOT ACCEPTED <br />