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� <br />P �,�MIT APPLICATIG.J <br />C17Y OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS �(�. PARCEL TAX I.D, li <br />�%/L� �D<' ��_;/ <br />LOT NO. I BLOCK I TRACT <br />DESC <br />TENANT NAt+tE <br />CONTRACTOR <br />PHONE D��v S Ci�L%�,U.(CJ�= <br />ADDRESS <br />NAME <br />� <br />a - a-o -- o Z <br />G �od <br />PHONE <br />CONTR. LICENSE N <br />PROPQSED USE Of BUILDING I TYPEIT � Spr nkle�non � S 9n b n9ai ITMPE LJ Fepa r/Idain� I HEAT SO� hRCE <br />n <br />f-( <br />LI Ll <br />CONTRACT PFiICE (1F WORK I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />NO. <br />l���L-li�c. )i i� <br />19RI�17I�[N <br />TYPE OF FIXTURE OR ITEM <br />INATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDFYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFI OW PREVENTER <br />SINK (SERVICEiBAR/WOP/ETC.) <br />N0. � TYPE OF FIXTURE OR ITEM <br />A/C —A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRY[R <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />F!FEPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEFEBY CEaITIFY THAT I HAVE READ AND EXAP.7INED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORFECT. ALL <br />PFOVISIONS OF LAWS AND OflIDINACES GOVERNiNG THIS NPE OF 1NORK WILL BE COh1PUED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. TH[ GRANTING OF A PEPh11T DOES NOT PRESUPdE TO GIVE AUTHORITY TO VIOWTE OR CANCEL THE PROVISION 0= ANY OTHER <br />STATE OR LOC.4L LAW REGULATItJG GONSTRl1CTION OR THE PERFORP.IANCE OF CONSTRUCTION. THAI' i AM AUTHORIZED 6V THE <br />OWNER OF THIS PFOPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />COMTRACTOFS L.1W 18.27 RCW AND 296.200 WAC. <br />. SignaWre of OwnedContractodAulhorized Agenl Date <br />