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� <br />I��RM�T AP'PLIC�T�JN <br />CITY OF E�lERETT PERMIT �ERVIGES <br />3200 CEUAR STREET, EVERETf', WA 98201 <br />425-257-8810 — FAX 4<:5-257-8857 <br />CoZc�l�-�/� <br />SITE A/DDRESS �7 PARCEL YAX l.D. N p.EpMi7 y <br />LEGA `�OT NO. / BL C 7RACT 1� �G ZO G1�) - ��% 3- ��- `�-- �.t0_`_►'_ <br />OESC. �' S�6'�� `i (-I`i'3- � �o -O I <br />�WNEA _ ennoece � ........_ . <br />7 <br />C1'i rU�(�j`-J'hL. <br />� <br />PROPOSED USE OF BUILDING <br />PERMIT <br />TYPE <br />PRICE OF'.YORK <br />CONTACT' <br />� � <br />: l0 _ l a� ��'� <br />�� �dP <br />�?S� G3&� <br />�.�a Y� l� l� _ <br />Bui�ding �}�����---MMM echanical <br />Combinalion �-�lumbing <br />Demolilicn � Sign <br />Sprinkler <br />PhIONE <br />CONTR. LICENSE # <br />�-� -� IzlYv�� <br />Addition <br />WORK Alleration <br />TYPE New <br />RepaidMainl. <br />HEATSOURCE <br />Elechic <br />as <br />O�her <br />CITY OF EVERETi LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION�_ <br />� f f� � � � � ��Yl'1..��' <br />NO. � TYPE OF FIXTURE OR ITEM <br />WAI tFi GLV;itl <br />BATHTUB <br />!_AVATORY (WASH BASIN) <br />SFfO�NER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTA�N <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (uERVICE/BAWRIOP/ETCJ <br />OTHER <br />�Sa;�,� c� �20/ <br />NO. � TYpE OF FIXTURE OR ITEM <br />A/G - �NHAPlDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTNES DP.YER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERITIFY 7HAT I HAVE REAO AND EXAh11tJ�D THIS APPLICATION AND KNOW THE SAME TO AE TRUE AND CORR�?CT. ALL <br />PROVISIONS OF �AWS AND ORIDINAC'c5 GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIEL HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES MOT PRESUME TO GIVE AUTHORITY TQ VIOLATE OR CANCEL THE PROVISION OF P.NY OTHER <br />STAT LOCAI LAW qEGULAT!(VG CONSTFUCTION OR THE PERFCRMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED EY THE <br />O_LN ER O HI TG5 F' FORM 7HE WOPK FOF WHICH APPLICATION IS MADE AND I COMPLY WITH 1'HE STATE <br />yc�NTRACT W 18.27 R A 296200 WAC. �/' /— <br />� <br />