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P`RMIT APPLICATIIrN <br />CITY OF EVEF�ETT PERMIT �ERVICES <br />3200 CEDAR STREET, E''JEFiETT, V�/A 98201 <br />425-257-8810 - FAX 425-257-8857 <br />l ��"' L✓: /�'l��f�� �' ��- /%�`= ��='� 7T <br />SITE ADDRESS <br />LEGA LOT NO. <br />DESC. <br />OLYNEfl <br />TENANT NAME <br />CONTF.ACTOR <br />PHONE <br />PROPOSED USE OF BUILDING <br />BLOCK <br />PARCE: TAX I.D. # <br />Yi:L[91 <br />ICONTACTNAME <br />A�DRESS <br />PERMIT R <br />TYP� D <br />U <br />Buiiding D Mechanical <br />Combination �j Plumbing <br />Demolilian U Sign <br />Sprinkler <br />ZIP <br />PERMIT # <br />�� 0�-0�1 <br />PHONE <br />CONTfl.UCENSE# <br />Addition HEAT SOURCE <br />WORK R Alteration (� ElecLic <br />TYPE D New � Gas <br />U RepaidMaint. Olher <br />CONTP.ACT PRILE OF WORK CITY OF EVERETT IOCAL SALES TA% CO�E IS 3105 <br />WORK DESCRIPTiON <br />� `�"'��CTS, <br />NO. I TVPE OF FIXTURE Ofl ITEM <br />WATEFiCLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL. <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINI:ING FOUNTAIN <br />FLOOR DRAIN <br />BACI<FLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER _ <br />NO. I T1'FE OF FIXTURE OR ITEh1 <br />A/C -A/HANDLING UNITS <br />FORCED AIR SYSTEI�iS <br />HEATPUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEfi00D <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CEFiITIFY'HA71 HAVE READ AN� EXAMINED THIS APPLICATIOh AND KNOW THE SAME TO BE TRUE AND CORFECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WOFK WILL BE COMPLIED WITH WHETHEA SPFCIFIED HEFEIN OR <br />N�.JT. THE GRANTING OF A PER�dIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHER <br />ST4TE OR ICCAL LAW REGULATNG CONSTRUCTION OR THE P[RFORh1ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 6Y THE <br />U4'JNER OF ThfIS PRGPEFi1Y TO Fci FORM THE WORK FOR WHICH P.PPLICATION IS h1ADE AND I COMPLY WITH THE STATE <br />CONTRACTOFS LAW 1927 R�VJ AND 296.200 WAC. <br />