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DDRESS <br />50�� ft <br />L07 NO. <br />' CT{ vv�..-� <br />'NAME <br />RMIT APPLICATI <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />BLOCK TRACT <br />AODRE <br />Z so u <br />PANCEL TAX I.C. If <br />PEflMIT N <br />Mona-oc�g' <br />��titn n,-+� � 9e�3 �s 339 - a�� <br />CONTACTNAME <br />�:C•l:ly <br />I SeK.J �lVr1{.GS <br />CONTRACTOA ���Mp� � �����ADDRESS 14�,� B��N��aa CO ���pH ��I <br />PHONE 1 l�.IG . yy� NE S' E� 'i 2Sl$'S <br />/�( -Z.9 � 3G S— ( �F 1 � <br />PROPOSED USE OF BUILdNG <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />NO. I T/PE OF FIXTURE OR REM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PfiEVENTER <br />SINK (SERVICElBAR/MOP/ETC.) <br />OTHER <br />Building AAechenical <br />PERMR RI-1 Combinalion � Plumbing <br />7YPE �,,./ Demolition U Sign <br />L �Sprinkler <br />Addition I MEAT SOURCE <br />Iteratlon Ele�.hric <br />New �Oae <br />Repair/Maint. U Other <br />CITY OF EVERETT LOCAL SALES TAX COOE 18 J106 <br />NO. I TYPE OF FlXTURE OR fTEM <br />A/C - AIHANDIING UNITS <br />FORCED AIR SYSTEMS <br />HEATPUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHO00 <br />WATER HEATER <br />METAL FIRF.PLACE/STOVE <br />FIREPLACE INSERT <br />QAS FIREPLACE P� PF c�.1 �-t.� <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER G�S 1Nd`�+.k�-E <br />!'� +►� w ��rc� tEEi�'7'�rL <br />I HEREBV CERITIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STA E OR LOCAL LAW REGUL4TING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OW R OF T,FjIS PROP RTY TO PERFORM THE WORK FOFi WHICH APPIICATION IS MADE AN� 1 COMPLY WITH THE STA1�E <br />CON ACTaR$ LAW�78�7 RCW ANO 296.200 WAC. <br />L� <br />