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PERMIT APPLICATIC4 <br />CITY OF EVERETT PERMIT SLkVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRESS c/o --wb f—l /. iti 'Ft PARCEL TAX I.D. N PERMIT # <br />_ 3&ci LU (,{5'.i'rJ L7d Y.jF.•.?ft� _ <br />LEGAIJ LOT NO. I' BLOCK I TRACT <br />Rif, scy//"f (cn. <br />trl.J <br />I�.O.Qr{.37�7 Kl�c dN-lj 9Pl.-"I-z7.-7 647G)3a�W-J 3(/3 <br />TENANT NAME <br />CONTACT FOR PERMIT <br />PHONE <br />/ak 73Tr 11 <br />(ins) 3Y2 --�-3v3 <br />CONTRACTOR <br />ADDRESS <br />ZIP CONTR. LICENSE N <br />PHONE <br />PROPOSED USE OF BUILDING <br />al <br />BuildingII�� <br />HEAT SOURCE <br />Combination Plumbing <br />bing <br />I TYPE <br />gun <br />L! Sign <br />U <br />TYPE <br />I <br />Repration nl. <br />er <br />CONTRACT PRICE OF WORK <br />/ 7 <br />Z OF(' <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 0105 <br />WORK DESCRIPTION <br />1 <br />/ / / <br />�PH/ouN' f kM�J. <br />l6/',4rv/ 1� /oc'CiSi..�r <br />— ?rfrrrJl/� f L�F,'�acAl2 <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />MECHANICAL <br />NO. TYPO OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />A/C - AIHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <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 />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TIPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A RMIT NOT PRE` )ME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR AL LAW R TING CO STRUCTIO DR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER THIS PROP RTY TO.PERFOR THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />AND 291 200 WAC. <br />.i' , <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />