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SRE ADDRESS <br />�- i <br />LOT NO. <br />DESC. <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />PARCEL TAX I.D. A <br />TRACT <br />CONTACT <br />oa i l - o <br />PERMIT # <br />PHONE <br />CONTRAC QR � RESS CO UCF,[j3E� <br />Unl,m��e�.��2���ahlCa� C.�O, i�niclti5� I���r��U.���,%l1�`%��IO tc�mouo r3011� <br />PHONE i � . . _ <br />PROPOSED USE OF <br />PERMR <br />TYPE <br />�:71C�,� �0.� <br />CONTR/1CT PRICE OF WORK <br />WORK DESCRIPTON <br />NO. � 7YPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRV TRl�Y <br />CLOTHES WASNER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLQW PREVENTER <br />SINK (SERVICE/BARlMOP/ETC.) <br />OTHER <br />Building <br />Combination <br />Demolition <br />Sprinkler <br />n Mechanical <br />64 Plumbing <br />D s�9� <br />Addition <br />acer�ra, <br />New <br />RepainMaint. <br />HEATSOURCE <br />�Elociric <br />Gas <br />01her <br />CIN OF EVERETT LOCAL SALES TAX CODE I51105 <br />NO. I TYPE OF F�%TURE 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 H�ATER <br />METAI P. EPLACE/STOVE <br />FIREPLA(. = INSERT <br />GAS FIREI LACE <br />GAS RANGc <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ /WD EXMIINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE ANU CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COIAPLIED WITH WHETHER SPECIFIED HtREIN 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 REGULIITING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I M1 AUTHORIZED BY THE <br />OWNER OF THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATI IS E AND I COMPLY WITH THE STATE <br />CONTRACTORS LA .27 BC� /WD� WAC. <br />"—� / l� _ <br />C/t l'�..�_ G.-� t � O� <br />SignaWro of Owner/ContracloUAulhorized Agent te, <br />n � � � <br />