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SITE ADDRESS <br />'���`� % <br />LEGA LOT N0. <br />DESC. <br />� P'ERMIT APPLICA� ION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EV�RETT, WA 98201 <br />425-257-8810 - FAX 425-2 i7-8857 <br />PARC�L TAX I.D. # PERMIT R <br />„�� ;�'� �5�. ce� _ Bo3��-o3�a <br />BLOCK TRACT <br />�"c Nf % ///Jd Cri� � <br />TENANTNAME <br />CONTRACTOR <br />� PHONE <br />�%%l� 3 . L.'! � C�/ �CNi� �'/,. <br />� PROPOSED USE OF BUILDING I <br />OJ I %�,�.,(' .f/ r' c.c� <br />I CONTACT FOR PERMIT <br />PERMIT <br />TYPE <br />CONTRACT PRICE OF WORN L� ��� b� <br />.y <br />WORK DESCRIPTION <br />.�:��r�.�.: �����'� <br />,��'��ir� �= s'�/ <br />oi iu� <br />N0. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOPIETC.) <br />OTHER <br />A�DRESS <br />�Buildinp <br />Combinatlon <br />Demolition <br />Sprinkler <br />ZIP PHONE <br />rl�u f� %(2,J�/ <br />PHONE <br />^ ZIP CONTR. LICENSE N <br />Mechanical <br />Plumbing WORI <br />Sign TVPE <br />n Addlllon <br />�'"� PJlerallon <br />�_( NBw <br />I�d'Repalr/Mainl. <br />HEATSOURCE <br />Electric <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALE9 TAX CODE IS �105 <br />NO. � TYPE OF FIXTURE OR ITFM <br />A/C — A/HANDLING UNITS <br />FORCED A�R SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERf <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />i HEREBY CERITiFV THAT I HAVE READ AND EXAMWED THIS APPLIC4TION AND KNOW THE SAME TO BE TRUE ANDCORRECT. ALL <br />PFOVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WIIL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANV OTHER <br />STATE OR LCCAL LAW REGJLATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY i O?FRFORh1 THE WORK FOR WHICH APPLICATION IS MADE AND I COMPL� "9TH THE STATE <br />CONTRA;TORS lAW 1B.2J i<CN AN� 296200 WAC. <br />�C/ � `7 ' % � � (' C `_ <br />ignature of wn /Conlractor/Aulhonzed Ayenl Dalo <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />