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� <br />SITE ADDRESS <br />26 ( 3 l <br />�or No. <br />'fSts <br />P4RMIT APPLICATI�.�V <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />VE <br />BLOCK <br />ra�cr <br />PAHCEL TA7( I.D.1 <br />6(S- ODL� 00- 08' <br />.Ta 1l�► �lCs ►,�Fu 183 z3 -12t� �q-� SE Stio �n� �s� . 9&zS L <br />TENANTNAME � CONTACTNAME PMONE <br />� <br />I ¢},gD v� � — <br />CONTRACTOR O� N�n ADDRESS LP COHTR. IICEN3E R <br />C:1� <br />PMOHE <br />PROPOSED USE OF BUILqN6 <br />S� ^� � I PERMIT <br />r 6lE � � rrne <br />CONTRACT PRICE OF WORK <br />WORK <br />I� �'tkt.� N� <br />N0. I TYPE OF Fl7fTURE OR REM <br />WATEq CLOSET <br />BATHTUB <br />LAVATOR� (WASH BASIN) <br />SINK 8 DISPOSAL <br />TRAY <br />URINAL � <br />DRINKING FOI <br />FLOOR DRAIN <br />BACKFLOW PI <br />_ SINK (SERV�CI <br />� <br />Buildfng � Mechenical Addiuon MEAT SOURGE <br />Combinetion Plumbing WORK B Alterelbn � E�ectric <br />Demolition Sign TVPE D New O�e <br />Sprinkler �� Repeir/Maint. OtMv <br />CITV OF EVERETT LOCAL SALES TAX CODE IS 7106 <br />� "I�o F .- �rt�-ztt �� � �oM �• -30 <br />NO. � TYPE OF FlXTUf1E OR ITEM <br />A/C —A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />NOE HOOD <br />_ W ER HEATEP. <br />_ MET FIREPLACE/STOVE <br />_ FIREP CE INSERT <br />_ OAS FIR IACE <br />� OAS f1ANQ <br />_ 4AS PIPING <br />_ EXHAUSTFAN <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW TME SAME TO BE TRUE AND CORRECT. AlL <br />PROVISIONS OF V+WS AND OFIDINACES GOVERNING THIS TYPE OF WOHK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GFANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEI THE Pf;OVISION OF ANY OTHER <br />STATE OR LOCAL lAW REGUL4TING CONSTFUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY ThE <br />OWNER OF PROPERN TO PERFORM THE WORK FOR WHICH APPIICATION IS MADE AND I COMPLY WITH TME STATE <br />CONTRA ORS 1Q„�77 RCW AND 298.200 WAC. <br />�� <br />a- <br />