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� <br />F3iT�111:1�: <br />L07 N0. <br />P RMIT APPLICATI�i�(V <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />BLOCK <br />TRACT <br />PARCEL TAX I.D. N <br />2�1 e�. �.r� <br />P MITM <br />Z �-oal3 <br />N�CI� MI►�+'r Sak�o(s� 47�0 C/N�y 1t'VICM�NC �19Zo1 <br />TENANT NAME CONTACT NAME PHONE <br />�Kt►Cl� f'k�H� sihio/s I lv��kt6r�+n� C��i't�/ frij'ccfs 3b0. 473a <br />CONTRACTOR <br />PHONE <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />M�su.u�c++ceH.r <br />rrirr� .�' r� <br />NO. i TYPE OF FlXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/8AR/MOP/ETC.) <br />OTHER <br />ADDRESS <br />uilding Mechanical <br />PERMIT Combination Plumbing <br />TYPE Demolition Sign <br />Sprinkler <br />CONTA. UCENSE � <br />Addilion <br />WORK Iteretio� <br />TYPE New <br />Repelr/Mainl. <br />NEATSOURCE <br />nc <br />es <br />Olher <br />CT/ OF EVERETT LOCAL SAIES TAX CODE IS 3105 <br />/�l�In�G�'lb'%I �N1.f C/►'�tiYN��f'7'dN {�' �'�'K. <br />n��i��,✓'�I� �xis�h'rv� ►�'h'c� sp� c�c. <br />ueruwu�nw� <br />NO. � TYPE OF FlXTURE OR REM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CL07HES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AIJD KNOW THE SAME TO BE TRUE AND COFiRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK N'ILL 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 OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFOFiMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />O\NNER OF THIS 9FOPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONi/iACTORS LAW 78.27 RCW AND 296.200 WAC. <br />Zd0?i `%2 <br />