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PC .RMIT APPLICATIC .V <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />�vaG /L,'�r�c, w �1�� <br />LEGA LOT NO. BLOCK TRACT <br />DESC. <br />n f U � 7c ,���ri�(S <br />NT NAME <br />CONTRACTOR <br />NW Enerc�� SY'rvic.as,JNe <br />PHONE <br />PROPOSED USE OF BUIL�ING <br />CONTRACT PRICE OF WORK [y' <br />PAR.r,EL TAX I.D. 8 <br />? �F�S r�l u K� ��c <br />�. I CONTACTNAME <br />PERMIT M <br />3 �zS�35S- �ryv <br />PHONE <br />ADDRESS 21P CONTR. LICENSE N <br />/a-y3Z fhuYSi Su.�fc'�7Z `%8ao`f /�iulEkEs.�9�1'9�y1 <br />Building Mechanical <br />PERMIT R Combinalion Plumbing �� <br />TYPE D Demolition Sign - <br />U Sprinkler <br />�� � <br />Addition <br />Alteralion <br />New <br />Repair/Maint. <br />HEATSOURCE <br />D'Electric <br />�� Gas <br />U Other <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />WORK DESCRIPTION /� � f� ` � n����. F / J <br />C,6IiC�?�^-� �i ?.e' .�u. i�.J��/ �.�pC�lAr' 7T� .la/� l�� S�,e <br />NO. I TYPE OF FIXTURE OR REM <br />'. /ATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISH6VASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRI� IKING FOUNTAIN <br />FLOOi� DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICElBAR/MOPlETC.) <br />OTHE�_ <br />NO. � TYPE OF FIXTURE OH ITEM <br />A/(: - A/HANDLING UNITS <br />� FORCED AIR SYSTEMS <br />HEAT PUMP <br />_ UNIT HEAT[RS <br />_ CLOTHES DRYER <br />RANGE HOOD <br />�, WATER HFATER <br />METAL FIREPLACE/STOVE <br />_ FIREPLACE INSERT <br />_ GAS FIREPLACE <br />_ GAS RANGE <br />� GAS PIPING <br />EXHAUSTFAN <br />_ OTHER <br />I HEi;EBY CEFiITIFY THAT I HAVE RF�1D AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TAUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHE7HER SPECIFIED HEflEIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLITE OR CANCEL TFIE PROVISION OF ANY OTHER <br />STATE OR �OCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTNORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFOfiM THE WORK FOR WHICH APPLICATION IS h1ADE AND � COMPLY WITH THE STATE <br />CQ[VTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />D/aJ/� ? <br />