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�— -... _ _ <br />��- ��RMIT APPLiCA�I''�,N <br />i�� Ci i Y OF EVERETT PERMIT SERVICES <br />3200 CED.4R STREET, EVERETf, VVA 98201 <br />425-257-8810 - FAX 425-257-Sf757 <br />SITE A[3DRESS <br />�/7ZZ <br />LEGA LOT NO. <br />DESC. <br />TENAN7 NAh1E <br />0 <br />CONTRACTOR,_ �.�--c� - <br />PHOR� / V1 ,, f� �d�i � �.i�l ti, <br />�S �1! Ss�( <br />PROPOSED USE OF BUILDINIi <br />�L►..���2.x — <br />CONTRACT PRICE OF WC 9K <br />�'/VMI� UCJI:MIYIIUfV <br />NO. I TYPE OF FIXTURE OA ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />C'_OTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER_ <br />PARCEL T.4X I.D. # <br />G?5� � Za -nr`ra�s . D <br />TRACT <br />S��arr Pc.r� � -o I <br />� ��'�1�� <br />NAME � <br />"-t�t4 _ I / � <br />_ � i°v�lv � %,/ <br />PHONE <br />�� <br />�G� � ZIP�G CONTR. LICENSE p ' <br />/ <br />�Y�� C.�'.� �J��fi�-�� (�Yrl <br />Building � �vlechanic <br />�eRMIT �Combination � Plumbing <br />TYPE Demolition Sign <br />Sprinkler <br />Addition <br />WORK Alteration <br />TYPE New <br />Repair/Maint. <br />HEATSOURCE <br />Electric <br />as <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />\� v - ' <br />-� ��-0� <br />NO. � TYpE OF FIXTURE OR ITEM <br />wi. — H/HANULINCi UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEAi ERS <br />CLOTHES DRYeR <br />RANGEHOOD <br />WATER HEATER <br />METAL FInEPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS FANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I h1EREBY CERITIFY THAT I NAVE READ AND EXAMINED THIS AFpLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS T� PE OF WORK WILL BE COPAPLIED WITH WHEfHER SPECIFIED HERE�N OR <br />NOT. THE GRANTING OF A PERMIT �OES NOT PRESUME TO GI'/E AUTHORITY TO V:OLATE OR CANCEI THE PRGVISION OF AtJY OTHER <br />STAT OCAL UTATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />O ER OF I ROPER ORM THE WORK FOR WHICH PLICATION IS MADE AND I COMPLY WITH THE STATE <br />ONTRACTOR LAW 1827 RC AN 2g6.200 WAC. <br />_ j�'z— <br />