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ERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />�� U c�— 425-257-8810 - FAX 425-257-8857 �7 <br />_��r?YZ I . i!� II �/ � `O/L' <br />SITE ADDRESS `T� <br />�� <br />LE6AL LOT NO, <br />DESC. <br />OWNER <br />C����✓�F'�S ��' <br />TENANTNAME � <br />Sc�.--�- <br />CONTRACTOR <br />U W �Je.�- <br />PHONE <br />PARCEL TAX I.D. N <br />TRACT <br />J��l,e„� S�. <br />CONTACT FOR PERMIT <br />ADDRESS <br />3�=13 CalS� .q� <br />PERMIT # <br />%�b31 0 `D�.S <br />ZIP PHONE <br />Z Sg ' /�� <br />PHONE <br />y1r� �7v -�yiL <br />ZIP CONTR. LICENSE X <br />%82�r <br />PROPOSEU USE OF BUILDING Building f'1 Mechanical AddiUon HEAT SOURCE <br />PERMIT Combination �_� Plumbing WORK Alteretion Q Electric <br />/� ,' )� � - � �,. TYPE Demolition �J Sign TYPE New �J Gas <br />Spnnkler Repair/MainL U OMer <br />CONTRACT PRICE OF WORK J rC ,- CITV OF EVERETT LOCAL SALES TAX CODE IS N05 <br />WORK DESCRIPTION • <br />�1 C.ti �� ��-4�- J "'`.C�p`-`__ <br />J <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK R DISPOSAL <br />DISHWASHER <br />LAUNDRY TF.AY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />NO. I TYPE OF PUCTURE OR ITEM <br />AIC — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEATPUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACEINSERT <br />GAS FIREPIACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS AP?LiCAT10N AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF L�1WS AND ORIDINACES GOVERNING THIS TYPE OF INORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF A�'Y OTHER <br />STATE OR L(�CAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOR12ED BY THE <br />OWNER OF THIS F'ROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE hND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 bVAC. <br />Signature of OwnedContractodAuthonzed Agent Date <br />[]EBIT & CREDIT CARDS ARE NOT ACCEPTED <br />�L <br />