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�E��MIT APP�ICATIO�� <br />ClTY' OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERET, WA 95201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE AL'DRESS PARCEL TAX I.D. # <br />�� i s 1� rn ba.e� �v U.�� �.�0�3 � <br />DESC.J � <br />OWNER <br />��..�; ��� <br />TEN,pNT NA� / _ , � <br />I i'1 �l l Iv.. 1 <br />ll✓ l. <br />CONTRACTOR <br />PHONE <br />PROPOSED USE OF BUILDING <br />P�.�xZ:, r �por�'.h <br />�x� <br />CONTRACT PRICE OF WORK <br />BLOCK TRACT <br />� ADDRESS <br />i ���� �I� <br />ICONTACT NAME <br />ADDRESS <br />PERMIT <br />TYPE <br />�l9uilding <br />Cbmbinalion <br />Damolilion <br />Sprinkler <br />RMechanical <br />Plumbing <br />� Sign <br />7YPE <br />� <br />PERMIT # <br />.Bo aoa-o�� <br />PHONE <br />ZIP CONTR. UCENSE M <br />Additicn HEATSOURCE <br />Aiteralion fI-''(�/.c� lectric <br />New [yj Gas <br />Repair/Main1. U Other <br />CITY OF EVEREIT LOCAL S.OLES TAX COOE IS 3105 <br />W OpK DESCRIPTION <br />��Ex�.�.r ��� �w��� �� � �h : �o� <br />boa��o�-� � <br />NO. � TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATH7U8 <br />LAVATORY (VJASH RASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FI.00R DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP;ETC.) <br />OTHER <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C -A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />FiEAT PUMP <br />UNIT HEATERS <br />CLOTHES C�YER <br />RANGE HOOD <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 CERITIFY THAT I HAVE READ AND E�CAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND COFRECT. AlL <br />PFOViSIONS OF LAWS AND ORIDINACES GOVEPNING THIS TYPE OF WORK WILI BE GOMPLIED WITH WHETHER SPECIFIED HEREIN OA <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOWTE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OF LOCAI LAW REGULATING CONSTRUCTION UR THE PERFOR�fANCE OF CONSTqUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRA�CTORS LAW 1827 RCW AN�29@200 WAC. <br />