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���RMIT APRLICATi`vN <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 />LEGA LOTNO. r � BLOCK <br />OESC. <br />OWNER <br />�� � .�o�� <br />TENANTNAME <br />� v��'KJ <br />CONTHACTOq <br />PHGNE <br />PROPOSED USE OF BUILDING I <br />PERMIT <br />TYPE <br />CONTRACT PRICE OF WOpK <br />WORK DESCRIPTON <br />M1-Pi �7^� (J'(�`� <br />�J <br />i� <br />TYPE OF FU(TURE OR 17EM <br />IwA i ER GLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFI.OW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />PARCEL TAX I,D. +� <br />TRACT <br />NAME <br />AODRESS <br />Bui�ding Mechanical <br />Combination R Plum6ing <br />Demolilion � Sign <br />Sprinkler <br />N0. <br />ERMIT I <br />cao�-oa,. <br />� <br />7aP CONTR. UCENSE M <br />RAddilion MEATSOURCE <br />Allaralion n Electric <br />BNaw F Gas <br />RepeiqMainl. LJ Othar <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />TYPE �F flXTURE OR ITEM <br />�va. — wnArvuLlNt9 UNITS <br />FORCEC AIR SYSTEMS <br />HEATPUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAI,ST FAN <br />OTHER <br />I HEREBY CERITIFY',HAT I F{AVE REA� ANO EXAMINE� THIS APPLICATION ANO KNOW THE SAM[ TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING T4I5 TYPE OF WOFK WILL BE COMPLIED WITH WHE7HER SPECIFIED HEREIN OR <br />NOT. THE GFANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOL4TE OR CANCEL THE PROVISION OF ANY OTHER <br />S7ATE OR LOCAL L4W REGUTATING CONSTRUCTION OR TF1E PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THI ERFOqM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CDN�(3pC�ORS LAW 18.27 AND 296.200 WAC. <br />7-�s���Z <br />