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C. �r2 <br />� <br />�RMfT APPLICATi�N <br />i�ITY OF EVER�TT PERMIT SERVICES <br />3200 C[DAR .:+TREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />>L, _�>�� .,, �i.„ �_ \ <br />ADDiiESS ,,�/ <br />� a (t� /i /o�/� %�'(� <br />LOT N0. BLOCK <br />DESC. <br />OWNER <br />�`O�' .�-GritS <br />TENANT :1AME <br />CONTRACTOR <br />PHONE DWI^�J <br />PROPOSED USE OF BUILOING <br />CO� A� ICE OF WORK <br />WORK DESCRIPTION <br />PARCEL TAX !:0. # <br />TRACT <br />NAME <br />lGK/� � <br />ADDRESS <br />Building Mechanical <br />PERMIT Combination R Plumbing <br />TVPE Demolilion d Siyn <br />Sprinkler <br />(/VOO a� //uc ClC.. <br />NO. I TYpE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SEHVICE/BAR/MOP/ETC.) <br />OTHER <br />PERMIT q <br />J�Zc <br />P//jF �NE <br />'" " y'� �!IS C <br />ZIP CONTR. LICENSE A <br />�Addi�ion I HEAT SOURCE <br />Alleration Electric <br />NeW � Gas <br />RepaiNMainL � Othsr <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />NO. I TYpE OF FIXTURE OR ITEM <br />_ 'v�—wnArvuuNGUNITS <br />_ FORCED AIR SYSTEMS <br />_ HEAT PUMP <br />_ UNIT HEATERS <br />_ CLOTHES DRYER <br />_ RANGE HOOD <br />_ WATER HEATER <br />_ METAL FIREPLACE/STOVE <br />_ FIREPLACE INSEAT <br />_ GAS FIREPLACE <br />_ GAS RANGE <br />_ GAS PIPING <br />_ EXHAUST FAN <br />_ OTHER <br />1 HEP.EBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVIS�ONS OF LAWS AND ORIGINACES GOVERNING THIS TYPE Of WORK WILI BE COMPLIEU WITH WHEfHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUTAE TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISION Of ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION UR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFQRM THE WORK FOA WHICH APpLICATION IS MAOE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 7827 RCW AND 296200 WAC. <br />`L <br />