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� <br />SITE ADDRf•SS <br />:CT N0. <br />PE�IMIT ApPLiCAT10���: <br />CITY OF �VERETT PERMf�� SERVICES <br />3200 CEDP,R STP,EET, EJERETT, WP. 98201 <br />425-?_57-8810 - FAX 425-257-8857 <br />PARCEL TAX I.O. # <br />BLOCK TRAC7 <br />.1 '�^�() � Cc..irn� <br />�tiN St�ti,�o��� 7�31 8r�v� Bla! c/kJd3 v�s-3�17-�535 <br />TENANTNAM[ � CONTACTNAME PHONE <br />CONTHACTOR <br />9:[U�l� <br />PROPOSED USE OF BUILDING <br />� � L+r N'! C <br />AODRESS <br />Biii�ding D Mechanical <br />PERMI7 R Combinalion U Plumbing <br />TYPE Demolilion �] Sign <br />Sprinkler <br />CONTRACT PFICE OF WORK �� C�� �— <br />WORK DESCRIP fION <br />� :t w1/'c�� ��Q�cv� <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASiN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOU�TAIN <br />F�OOR DRAIN <br />6ACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />ZIP <br />I� <br />� <br />� <br />� <br />CONTR. IICENSE N <br />Addilion NEAT SOURCE <br />APeration Elednc <br />New Gas <br />RepairRAainl Olher <br />CITY OF EVERETT I.00AL SALES TAX CO�E IS 3105 <br />N0. I TYFE OP FIXTURE OR ITEM <br />A!C —A/HANDLING UYITS <br />FORCED AIR SYSTEMS <br />HEA'f PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WAi'ER 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 THAT I HAVE READ ANO EXAMINED THIS APPUCATION AND KNO�V THE SAL1E TO BE TPUE AND CORRECT. ALL <br />PROVISIONS OF L1WS AND ORIDINACE$ GOVE9NING THIS TYPE OF WORK WILL BE COPAPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT OOES NOT PRESUM1tE'O GIVE AUTHORITY TO VIOL4TE OR CANCEL THE PFOVISION OF ANY OTHER <br />STATE OH LOCA: LAW REGULATING CONSTRUCTION OF THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNEH OF THIS PiiOPERN TO PERFORM THE WOFK FOR 4VHICH APPUCATION IS MADE AND I COAIPLV WITH THE STATE <br />:ONTHACTORS LAN! 1927 RCW AND 296200 WAC. <br />