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SITE ADDRESS <br />LEGA LOT NO. <br />DESC. <br />OWNER <br />�I�.� <br />TENANTNAME <br />CONTRACTOR <br />PHONE �` _ <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETf, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />�-h s <br />3LOCK <br />'7 7 S -7377 <br />PpOPOSED USE OF BUIL�ING <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />��� � P� <br />PLUMBING <br />NO. � TYPE OF FIXTURE OR ITEM <br />� WATER CLOSET <br />�_ BATHTUB <br />�LAVATORY (WASH BASIN) <br />SHOWER <br />—T KITCHEN SINK & DISPOSAL <br />= DISHWASHEF <br />LAUNDRY TRAY <br />J_ CLOTHES WASHER <br />_, URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />ACKFLOW PREVENTER <br />SINK (SERVICE/BAWMOP/ETC.) <br />� OTHER � O�' b i 1�_ <br />PERMIT <br />TYPE <br />PARCEL TAX I.D. S <br />TRACT <br />�� <br />\.sv /- J <br />ICONTACTNAME <br />� <br />PERMIT x <br />PHONE <br />ADDRESS � O �u G 1S7 ZIP CONTR. LICENSE M <br />� r�r,nx7s �1 P�b <br />�b�Nw scx�TN +� ��?oa <br />gBUilding MeChaniCal �ddilion HEAT SOURCE <br />Combination Plumbing WORK leration [} Eiectric <br />BDemolilion ign TYPE New � Gas <br />Sprinkle� RepairlMaint. O�her <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />, U� �T� � !`� Yl� 1 �/ <br />NO. I TYPE OF FIXTUflE OR ITEM <br />AIC —A/HANDUNG UNITS <br />FOFCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DFYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXFiAUST FAN <br />QTHER <br />1 HEFEBY CERITIFY THAT I HAVE READ ANC EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND OFIDINACES GOVERNING THIS TYPE OF WOFK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GP,ANTING OF A PERMIT DOES I:O' PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOGAL LAW REGULATING CONSTHJCTION OR THE PERFORMANCE OF CONSTRUCTIOY. THAT I AM AUTHORIZED 8Y THE <br />OWNER OF THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1.2 RCW AND 296.270 WAC. <br />�h /il � ��'���%i <br />