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���IVIIT APPLICATIOI`: <br />CITi' OF CVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVF'ZETT, W�� 98201 <br />425-257-8810 - FAX � 15-257-885� <br />SITE ADDRESS PARCEL TAl( I.D. N Pf:RMiT #�CO� "OU7 <br />C�/l i /"l�._..�tun./ I I''�9"�fU'�''93� <br />DESC. <br />LOT NO. � � BLOCK � TRACT <br />f -C �� <br />-- - paD Pt��»�;h� <br />PHONE <br />PROPOSED USE OF BUIIDING <br />PERMIT <br />TYPE <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOIL[T) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LALNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />CONTACT FOR PERMIT <br />ADDRE55 <br />79 �`t Sr¢t..�, R�Q <br />Building <br />Combination <br />Demolition <br />Sprinkier <br />�Mechanical <br />Plumbing <br />Sign <br />rnvn� <br />ZIP l:Un I n. �wenac w <br />9P'z`•;v DD P�li v�7 kT <br />Additlon <br />WORK Alteration <br />TYPE New <br />Repair/Malnt. <br />HEATSOURGE <br />�Electric <br />Gas <br />Other <br />CITY OF EVERETT LGCAL SALES TNC CODE IS 3105 <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATC-R <br />METAL FIREPLA�E/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEP.EBY CERITIFY THAT I HAVE READ AND EXAMINED Th'IS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIGD 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 ANY OTHER <br />STATE OR LOCAI. LAW REGULATING CONSTRUCTION OR TI1E PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />UWNER OF THIS PROPERIY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />��� <br />DEBIT 8 CREUIT CARDS ARE NOT ACCEPTED <br />