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P��3MIT APPLICA►TI(:.d <br />CITY OF cVERETT PERMIT SERVIC�S <br />_ 3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />.a � <br />SITE ADD ESS <br />/l <br />LEGA LOT N0. <br />DESC. <br />OWtJEFi <br />�� (/�- <br />TENANT NAM1tE <br />PARCEL TAX I.O. # <br />BLOCK TFACT <br />ADDflESS <br />5 ox ��y 7 <br />, � CONTACT NAME <br />� <br />CONTRACTOR AODRESS <br />��O��C� �.J s�%z �ii c ���C.�c'1�5i�'� <br />PHONE <br />� <br />I PROPOSED USE OF BUIL�ING I� Building f1 Mech&nical <br />PERMIT � � Combination `�F Plumting <br />� TYPE �,� Demolilion LJ Sign <br />U Sprinkler <br />CONTRACT PRICE OF WOFiK <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATEFi CLOSET <br />_.�_ BATHTUB <br />_ LAVATOHY (WASfi BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDfi\' TRAY <br />� CLOTHFS WASFIEP <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACI<FLOW PREVENTER <br />SINK (SERVICEiB.4R/MOP,�ETC.) <br />OTFIER <br />�-34-0 <br />PERMIT # <br />i� 0 a ( (7 "G'05 <br />��o� <br />PHONE <br />ZIP CONTR. LICENSE d <br />�dtlition <br />WORK Alleration <br />?YPE New <br />RepaidlAaint. <br />HEATSOURCE <br />E12C�riC <br />Gas <br />Olher <br />CITY OF EVEREfT LOCAL SALES TA% COOE !S 3705 <br />NO. I TYPE OF FIXTURE OR ITEM <br />� <br />� <br />' A/C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEATPUMP <br />UNIT HEATERS <br />CLOTHES DFiYER <br />RANGEHOOD <br />WAT(=R 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'HAT I HAVE READ AND EYAh71NED THIS APPUCATION AND KNOW THE SAME TO BE TRUE FND CORFECT. ALL <br />PROVISIONS OF 1�1W5 AND ORIDINACES �30VERNING THIS T'!PE OF WORK'NILL BE COM1IPLIED `NITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GFANTING OF A PEP.MIT DOES NOT PRESUh1E TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OP ANY OTHER <br />STATE OR LOCAL I.AW REGULITING CONSTFUCTION OR THE PERFORM11ANCE OF CONSTRUCTION. THAT I P.Id AUTHORIZED BY THE <br />OWNER OF THIS PROPERN TO PERFOR�d THE :"JORK FOR WHICH APPIICAT10N IS IdAOE AN� I COMPLY WITH THE STATE <br />CCNTRACTOP.S LAW 1 B27 FCW ANO 296..00 WAC. <br />L �'L'E' ��.,d-EZ'.-c„�.r� / D --, f21 =� p •� <br />re <br />