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� <br />� <br />�- _— -, <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />f-, ( n� a d- I 9 is -) S'" .t�SE) 425-257-9810 - FAX 425-257-8857 <br />I <br />SITE ADDRESS <br />��0 S <br />LE(;A LOT N0. <br />DESC. <br />OWNER <br />TENA� <br />CONTRACTOR <br />PARCEL TAX I.D. 0 <br />S� � <br />BLOCK TRACT <br />ADDRESS <br />�f—.�9a f 7 s' S�� S� <br />CONTACT NAME <br />PHONE U��� <br />PHOP03ED USE OF BUILDINO <br />CONTRACT PRICE OF WORK <br />ADDRESS <br />Building <br />PERMIT � Con7binnllon <br />TVPE Domolilion <br />Sprinkler <br />WORK DESCRIPi10 <br />�v.5�.�,� 7 �' r� p � �, � <br />N0. I TYPE OF FI%TUR[ OR ITEM <br />WATER CLOSET <br />DATHTUD <br />LAVATOfiY (WASI-i �l1SIN) <br />SHOWER <br />KITCh1EN SINK 8 DISPOSAL <br />DISIiWASHER <br />LAUNORYTHAY <br />CLOTHES t'!ASHER <br />UfiINAL <br />DfiINKING FOUNTAIN <br />FLOOFl DRAIN <br />OACKFLOW PREV[NTER <br />SINK (SERVICE/�AR/MOPIETC.) <br />OTHER <br />21P <br />PERMI? M <br />���.� n3z <br />as=y3�� �y <br />PHONE <br />CONTR. UCENSE 1 <br />�Aechenlcal n Addllion <br />Plumbing WOAK ❑ A'leiolion <br />Slgn TYPE �17'f1Bw <br />U flepeir/Mainl. <br />.�,.rv� c� c� <br />N0. <br />HEATSOURCE <br />[� Eleclrk <br />g oas <br />Olher <br />CITY OF EVERETT LOCAL SALEB TAX CODE IS 7f06 <br />�t- � �-} wo r k . <br />MECHANICAL <br />I TVPE OF flXTURE OR ITEM <br />(yC — NHANDLINp UNIiS <br />FORCED AIR SYSiEMS <br />HEAT PUMP <br />UNIT HEAT[RS <br />CLOTHES DRYEfl <br />RANOEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />OAS �IREPLACE <br />(jA5 RANOE <br />OAS F'IPIN6 <br />EXHAUST FAN <br />OTHER <br />I H[REDY CERITIFY T11A1 I HAVE READ AND EXAMINED THIS APPUCA710N AND KNOW THE SAME TO BE TRUE AND CORFIECT. ALL <br />PROVISIONS OP IAWS AND OfiNINAGES (iOVERNINO THIS TYPE OF WORK WILL BE COMPLIED WI1N WHEtHEH SPECIFIE� H[REIN OR <br />NO7. TH[ Gt;ANTING OF A PERMIT DOES NOT PRESUME TO OIVE AUTI10f11TY TO VIOl.n7E OR CANCEL THE PROVISION OF ANY OTHER <br />STA7E OR LOCAI I.AW REGULATINO CONSTI7UC710N Ofi THE PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BV THE <br />OWN[R Of THIS PROPEfiT� T PERFORM THE WOHK FOH WHICH APPUCATION IS MADE AND I COMPLV WITN THE STATE <br />CONTRACTORS LAW l8� R� AND 29QR00 WAC. <br />