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SITF. ADDRESS <br />����/ � <br />LEGA LOT N0. <br />DESC. <br />OWNER <br />fit ✓.L,i.LiGc <br />JiNANTNAME <br />/� �/a �"Y- <br />CONT(iACTOR <br />PHONE <br />PE�rtMIT APRLICATIO�v <br />CITY OF EVEREI'T i�ERMIT SERVICES <br />3200 CEDAR STRtET, FVERETT, WA 98201 <br />425-257-8810 - FF.X 425-257-8857 <br />������ � �.s <br />� e�ocK I <br />yP.Gi // Y' CC� •'� <br />�r�.�`4�s <br />�- <br />PROPOSED USE OF BUILDING <br />�+�a%:-fi�� <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />� � � ��� <br />.`/ / <br />NO. � TYPE OF FIXTURE OR ITEM <br />WATER CIOSET (TOILET) <br />BATHTUB <br />LAVATCRY (N/ASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />IAUNDRYTRAY <br />CI.OTHES �VASHER <br />URIMAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />S W "< (SE RVICE/BAR/MOPIETC.) <br />OTH�R <br />PARCEL TAX I.D. p <br />TRACT <br />,� %=M.)�/� i� /. <br />CONTACT FOR P RMI' <br />���� <br />J h/�' �..7n,u�'r. <br />PERMIT # <br />So�l o�-� <br />PHONE � - <br />u. <e�: •. . <br />PHONE <br />�/1 S -<': �'i - /�.Z. Z <br />ADDRESS ZIP CONTR. LICENSE` k_ r �. <br />, / , 1 �1 I <br />�' � %� He �-! �: �; �--�.,ti�.. <br />Buliding Mechanical <br />PeRMt7 R Combinalion � Plumbing <br />TYPE D Demalitlon Sign <br />U Sprinkler <br />Additlon HEAT SOURCE <br />Alteratlon Electdc <br />New � Gas <br />Rapalr/Maint. Othet <br />CITY OF EVERETT LOCAL SALES TAIf CODE IS J10S <br />N0. I TYPE OF FIXTURE UR IT1:M <br />A/C — A/HANDLING 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�AN <br />OTHER .+��'_T__ <br />i HEREBV CERITIFY THAT I MAVE READ AND E)(AMINED THIS APPLICATION AND Y.NOW THE SAti1E TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVFRNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIE� HEREIN OR <br />PlOT. THE GRANTING OF P PERMIT DOES NO � PRESUME TO GIVE AUTHORITY TO VIOLATE OR C.�N`iCEL TNE PROVISION OF ANV OTHER <br />STATE OR LOCAL LAW F:EfULATING CONSTRUCTION OR �H[ PERFORMANCE Of CONSTRUCTIUN. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERi'Y TO PERFORM THE \NORK FOR WHICH APPIICATION IS IdADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LPW 18.27 RCW AND 296.200 WAC. <br />i ' �' � ��S _ 2 �!! <br />Signature of 0 ntracror/Au�honzed Agent Dale � <br />L <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />