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" � P�RI'JIIT APPLICATIO�N <br />E,, ^.ITY OF F:VERETT PERMIT SERVICES <br />3200 CEDAR �TREET, EVERETf, WA 98201, 425-257-8810 <br />SITc ADORESS <br />:L�� <br />DESC. <br />OWNER <br />�_ t `^�— <br />TENANT AME <br />CONTHACTOR <br />17:L�1:1? <br />PARCEL TAX I.D. N <br />ADDRESS <br />CONTA.C' NAME <br />ADDI?ESS <br />u <br />PHONE <br />CONTR. LICENSE # <br />PROPOSED USE OF BUILDING � Building � Mechanical Addition HeAT SOURCE <br />PERMIT Combination Pl9mbing WORK � Alteration � Electric <br />TYPE Demolition Si n TYPE New Gas <br />�1�, Sl��.,� Sprinkler Repair/Maint. Oiher <br />COiJTRACT PRICE OF WORK ��O�D CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION ��.¢8 �%�H, PyE �L�T s�Lii�'/LiV ZU �X�SZ—l/iIE> <br />�l�E STATlUV �/D, �o GUlfIC�}} GUlLL -�}bD (/) 7�2G�/L �,9�J � <br />��,v� z�t� Uai� �g�z��s . <br />Np, � TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHT'JB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />NORY TRAY <br />�HES NJASHER <br />DRINKIN OUN;AIN <br />FLOOR DRAI <br />� BACKFLOW P9 N <br />SINK (SERVICE/BA <br />OTHER <br />� <br />.) <br />�0. I TYPE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEP�IS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />NGE HOOD <br />W ER HEATER <br />MET FIREPLACE/STOVE <br />FIREP E INSERT <br />GAS FIR CE <br />GAS RANG <br />GAS PIPING <br />EXHAUSTFAN <br />_� � <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL �. <br />PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS IYPE OF WOFK WILL BE COMPLIED WRH WHETHER SPECIFIED HEREIN OR <br />NOT. TH[ GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL�THE PROVISION OF ANY OTHER <br />STATE OR LOCAL IAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPER7Y TO PERFORM THE WORK FOI; WHICH APPLICATION IS MADE AND I COMPL'/ WITH THE STATE <br />CONTRACTORS LAW 7827 F AND 296.200 WAC. n� . 2/G/ � <br />� <br />Signature of OwneriCo tra odAuthorized Agent ate ��� <br />