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SITE ADDRESS <br />LOT N0. <br />CONTRACTOR (� � � �„� � Y <br />PHONE <br />3L�c • ��. 4 <. <br />PROPOSED USE OF BUILDING <br />F�tRMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />BLOCK I TRACT <br />�1Cnk.•�� <br />PARCEL TAX I.O. It <br />�u11. `ti3r�� �i 54� �l�Gdo <br />CONTACT FOR PERMIT <br />`rc, c .i L.� ��+✓c.Ji�l L �C �r'. <br />Building Mechanir.al <br />PERMIT � Combinalion � Plumbing <br />TYPE Demolition Sign <br />Sprinkler <br />CONTRACT PRICE OF WORK <.,� � <br />WORK DESCRIPTION <br />l� �-,1,<<, ���- ���� � <br />PLUM6ING <br />NO. I NPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (1NASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREV[NTER <br />SINK (SERVICE/BAR/MOPIETC.) <br />OTHER <br />� <. <br />c^ <br />ZIP <br />PEFMIT # <br />m o3 <br />PHONE <br />41 ; �V �l <br />Pj10NE <br />Sc� F o l G; <br />CONTR. LICENSE N <br />`�i };'7 `i cl �'i A c tti F= H x LI <br />Addllion I HEATSOURCE <br />Alterallon I Eleclnc <br />New '' � �� � y � Gas <br />Repair/Main1. I Olher <br />CITY OF EVERETT LOCAL SALES TA% COOE IS ]705 <br />NO. I TYPE OF FIXTURE OR ITEM <br />�� <br />A/C — NHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREHLACE/STOVE: <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />L � AL� 4-Ir��ci <br />� HEREBV CEitITIFV THAT I HAVE READ ANU EXAMINED THIS APPLICATION AND KNOW THE �AME 70 BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS ANO ORIDINACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOt. THE GRANTING OF A PERMIT DOES NOi PRESUME TO GIVE AUT�IORITY TO VIOL4TE OR CANCEL THE PROVISION OF ANV OTHER <br />STA1E OR LOCAL LAW REGULATING CONSTRUCTION OR TNE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF 1HIS PhOPERTV TO PERFORM THE WONK POR VVHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />COtNTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />\�e�'a�( 1—�L ) . 'i ' S <br />Signature of OwnadContractar Au�lonzed Agent Date <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />� <br />