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SITE <br />��RMIT APPLICATI�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 42�-257-8857 <br />� � �C Lf S ✓ <br />LOT NO. BLOCK <br />� [�/ <br />TENANT NAhiE <br />CONTRACTOF <br />,Dl9�PS � �' � � i C { <br />PHONE <br />PROPOSED USE OF BUILDING <br />CONTFiACT PRICE OF WORK <br />WORK OESCRIPTION <br />PARCEL TAX I.D. X <br />TRACT <br />!O .�a� �Sy� �;.�-� <br />, CGNTACTNAME <br />A�DRESS <br />��/-u u^ /S <br />I Building n Mechanical <br />PERMIT R Combinalion �Elum6ing <br />TYPE Demolifion � Sign <br />Sprinkler <br />lb_Jl—UZ <br />PERMIT N <br />i� - �s <br />PHONE <br />ZIP CONTH. LICENSE N <br />Addition HEAT SOURCE <br />WORK Alteration [lectric <br />TYPE Ne�v Gas <br />Repair/�daiN. Olher <br />GTY OP EVERETT LOCAL SALES TAX CDOE IS 3105 <br />PLUMBING , MECHANICAL <br />NO. I TYPE OF FIXTUFE OR ITEM <br />i�— WATEF CLOSET <br />, _L BATHTUB <br />LAVATORY (WASfi BASIN) <br />SHOWER <br />� �— KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TFAY <br />� CLOTHES'JJASHER <br />UFINAL <br />DRINKING FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREV[NTER <br />SINK (SERVICEiBAR/MOP�ETC.) <br />OTIiER <br />NO. � TYPE OF FIXTURE OR ITEM <br />_ A/G — A/HANDLING UNITS <br />_ FOFCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT I�EATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />� WATER HEATER <br />_ MFTALFIP.EPLAC[lSTOVE <br />_ FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />_ GAS PIPING <br />EXHAUSTfAN <br />OTHER <br />I HEFEBY CERITIFY THAT I HAVE REA� AND EXAM1IINED THIS A�PPLICATION AND KNOW THE SAG1E TO BE TRUE ANC CORRECT. ALL <br />PROVISIONS OF LAWS AMD ORIDINACES GOVEFNING THIS TYPE OF WORN WILL BE COM11PLIED WITH WHETHER SFECIFIED HEREIN OR <br />NOT. THE C,RANTWG OF A PERMI' DOES NOT PRESUM1fE TO GIVE AUTHORITY TO VIOL.ITE OR CANCEL THE PHOV SION OF dNV OTHER <br />STATE OR LOCAL LAW FEGULATING ;ONSTRUCTION OR THE PERFORh1ANCE OF CONSTRUCTION. THAT I AM AU`NCRI2ED 0Y THE <br />OWNER OP THIS PROPERN TO PERFCFAI THE WORK FOR WHICH APPUCATION IS MADE AND I COM1IPLY WITH TH[f STATE <br />CON7RACTORS L4W 18.27 RC'N AND 296200 WAC. <br />(� - / o i� Z-- <br />