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SITE�DRESS <br />�� <br />LEGA LOT NO. <br />TENANT NAME <br />P�RMIT APP�.ICAT1�`N <br />CITY OF FVERETT PERMIT SERVIC:�S <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />�� C �-1' ✓ <br />� BLOCK <br />TRACT <br />PARCEL TAX I.D. # <br />NAME <br />a -, -02 <br />PERMIT k <br />PHONE <br />CONTRACTOR A�ORESS ZIP CONTR. LICENSE q <br />�f4JC-S Sc�2l//CF /��C!!7/j/�L- 3S�//Gr/�Oht��' l�-J� �r?rl�sso�/(oSt; <br />PHONE � v e 2e T/ <br />i`�71�! <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />,�-�- T� <br />� a �e <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSFT <br />BATIiTUB <br />LAVATORY (W.4SH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHE� <br />LAU�+DHY TRAY <br />CLUTHES WASHER <br />URINAL <br />DAINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAFUMOP/ETC.) <br />Building Mechanical <br />PERMIT � Combinalion � Plumbing <br />TYPE Deinolilion Sign <br />Sprinkler <br />p�pi��,- � �G <br />W �q-s {� e rL <br />Addition HEATSOURCE <br />WORK Alteralion ElecVic <br />TYPE New � Gas <br />Repair/Mainl. Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />N0. I TYPE OF FIXTURE OR ITEM <br />A!C —A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER `iEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RAN�E <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HERE�Y CERITIFY THAT I HAVE FEAD AND EXAA7INED THIS APPLICATiJN AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF tAWS AND OAIDINACES GOVEFNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHEH <br />STATE OR LOCAL LAW REGI:LATING CONSTRUCTION OR T;1E PERFOFMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 8Y THE <br />OWNER OF THIS PROPERN TO PERFORM THE WORK FOR VJHICH AFPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTOFS LAW 78.27 RGW AND 296200 WAC. <br />�- — � - C� Z_ <br />