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�cRMIT APPLICATi�lN � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.N PERMIT r <br /> ya�, v rno3�z-o! <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. l, -Z� \p��i ����, <br /> OWNER ADDRESS LP PMONE <br /> ��. � �- �-�, ��z�� <br /> TENANTNAME I CONTACTNAME PHONE - <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSEN <br /> PHONE `\ ,� � y\� � <br /> (C��_ V <br /> PROPOSED USE OF BUILDINO pERM1T � Sprinklleat(�n�'R P u bing I WORK � RepelrMtalnL H�TSE�� <br /> 7YPE Demolflion � Sfgn TYPE New �] �?er <br /> U <br /> CONTRACT PRICE OF WORK '��-"�� _ Z�O •'CITV OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> W�DESCRIPTIO� � g� -� ` _�� �\�`h\ _ \ ,.,..� <br /> \�a 7C `T�.� 9�1)��' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR REM NO. TYPE OP Fll(TURE OR ITEM <br /> _ WATER CLOSET(TOILET) A/C-A/HANDLINti UNITS <br /> _ BATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) HEAT PUMP <br /> _ SHOWER UNITHEATERS <br /> _ KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> _ DISHWASHER RANGE HOOD <br /> _ LAUNDRYTRAY � WATER HEATER <br /> _ CLOTHES WASHER METAL FIREPLACE/STOVE <br /> _ URINAL FIREPIACE INSERT <br /> _ DRINKING FOUNTAIN � GAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS RANOE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> _ OTHER _ OTHER <br /> I HEREBY CERITIFY THAT I HAVE FEAD AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORID�NACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEHEIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TH�PROVISION OF ANY OTNER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTMORIZED BY THE <br /> OWNER OF THI5 PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 2 .200 WAC. <br /> �. ��� a3 <br /> Signature OwneU ontractor/Authorized Ag t ate <br />