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SITE ADDRCSS <br />�'7 ,'("�� �%, <br />�o; No. <br />�3 <br />TENANTNAME <br />PtRMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />5200 CEDAR STREET, EVERETf, WA 9f1201 <br />425-257-8810 - FAX 425-257-8857 <br />PARCEL TAX I.D. p <br />BLOCK � I TRACT <br />CONTAC?FOR <br />P RMIT 1 <br />�— c� - D/ <br />ZIP PHONE `<�ZcJ— <br />/ <br />i.[�z.�tB�a 3`%S-��'n3 <br />� PHONE <br />�/2S) 3Ys =G <br />CONTRACTOR �+ /J� ��m F S, �"'�Z AUDRESS �Q� / L�� �j'"je j7'¢/� V�NtiLIP CONTR. LICENSE p <br />�� miift7svtr��� ccry� ',?�Za G,PCNdL�f'c07��tN <br />PHON�y2 S � 3YS�-G �� <br />PROPOSED USE OF BUILDING I y� Building I'") Machanical Addition HEAT SOURCE <br />PERMIT ,�I�1( Combinati�n H Plumbing WORK RI—( Alterauon Q Electnc <br />TYPE u Demolilion U Sign TVPE �% New I u Gas <br />/�iF[.c.l Ic�-5�'z � Sprinkler U Repalrr;nalnl. U Other <br />CONTR�>CT PRICE OF WORK <br />WORK DESCRIPTION �i ( �C /7,�5/C <br />/� � 4./ <br />NO. I TYPE OF FIXTURE OR ITEM <br />� <br />'NATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CL07HES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP�ETC.) <br />OTHER <br />CITV OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />N0. I TYPE OF FI%TURE OR ITEM <br />� <br />� <br />A/C — A/FIANDLING UNITS <br />FORCEC AI:2 SYSTEMS <br />HEAT PUM� <br />UNIT HEt � ERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL =1REPLACE/STOVE <br />FIREPL,aCE INSERT <br />GAS FIFtEPLACE <br />GAS RANGE <br />GAS Plf'ING <br />'eXHAUSTFAN <br />OTHER _ <br />. i HEREBV CERITIFV THAT I HAVE READ AND EXAMINEC TH:S APPLICATION AND KNOV: ?HE SAME TO BE TRUE AND CORRECT. ALL <br />, PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPFGFIED HEREIH OR <br />, NOT. TH'c GRAN ING OF A PERMIT DOF:S NOT PRESUME TO GIVE AUTHURITY TO VIOL4TE OR CANCEL THE PROVISION OF ANV OTHER <br />��, STATE OR LOC LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZEO BY THE <br />' OWNER O PROPERT� O PERFO� THE WORK FOR WHICH APPL CATJ0N IS MADE AND I COMPLY WITH THE STATE <br />I CONTR T S LAW 1B.�IRqvV AND �66.260 WAC. / / <br />� <br />ignaWre of � <br />i <br />�� <br />a� <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />�IL <br />