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r, <br />PERMIT APPLICATION� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREEf, EVERETT, WA 982l11 <br />425-257-8810 — FAX 425-257�857 <br />SITE ADDRESS <br />502 � <br />LEGA lOTNO. BLOCK <br />DESC. �� <br />pWNER <br />F�o6�.rs�o �a�r� <br />TFNANTNAME <br />�pN �„�,nc�l-c <br />cortrn�erore �,�p <br />PHONE <br />PROPOSED tIBE OF BUILDING pERMR <br />�: LI N GN�Ci� C; �j�/ T'PE <br />COHTRACT PRICE OF WORK ` <br />I PARCEL TAX I.D. i <br />(L <br />rn�cr <br />ADDRE55 �' Y�'T .�I`, f� Sl. <br />�s uuu n►r��r1 oN � <br />CONTACT FOR PERMR <br />-�N ��A"t 5 <br />�ooaess <br />Building <br />Combinafion <br />Demditbn <br />Sprinkler <br />WORK DESCRIVTION � F� �`� -� <br />,-�t�.l.r �r-lY�-o <br />�I T'T'1 N'1(x R�O N( GOQM � I-�r.K-ES V� 17`� 7�� �D ITI b 1�! <br />U rG V� ���� rJv �� ��� ucrueul("el <br />PERMIT N <br />PNONE <br />ZOt�. (v 22 • �`I <br />zm conrn.uceNses <br />RMechenipl �°f <br />Plum6ing MNRK A�e�h°" <br />D Sign 7YPE New <br />RepeilMeint. <br />HEATSDURCE <br />n Elatttic <br />HGas <br />LJ Othe� <br />CITY OF EVEREl7 LOCAL SALES 7AX c We � s�ua <br />�.�►�l o C7Et-i r.i �- pF 'EK-Is�n /�! �i <br />NO. I NPE OF FIXTURE OR ITEY <br />WATER CLOSET <br />BATHTLB <br />LAVATORY (WASH BASIy) <br />SHOWER <br />KITCHEN SINK 8 DISP0.SAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICElE3AWMOPIETC.) <br />OTHER <br />NO. I TYPE OF FIItTURE OR ITEY <br />AIC - AIHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HFATERS <br />CLOTHESDRYER <br />RANGEHOOD <br />WATER HEATER <br />�AETAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />O� <br />I HEREBY CERITIFY TMAT 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 TYPE OF WORK WILL BE CAMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTINCa OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGIILATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCT'7N. TNAT 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORIC FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RC1N AF1D 296.20U WAC. <br />Signature of OwnedContreda/Authorized Agent Dete <br />DEBIT 8� CREDIT CARDS ARE NOT ACCEPTED <br />