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PE�RMIT APPLICATI�I <br />cir�r o�= EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 . <br />SITE ADDRESS <br />��?��=''AVeS� <br />LEGA LC�iMO. BLOCK <br />DESC. i I <br />CONTRACTOR � ��,�C� <br />J <br />PHONE <br />PROPOSED USE OF BUILDING <br />S� � <br />CONTRACT PRICE OF WORK <br />WORK DESCRIP770N <br />5��- <br />NO. <br />✓�'�5 <br />TYPE OF FIXTURE OR REM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />IAUNDRY TRAY <br />CLOTHES WASHER <br />URINAI <br />DRINKING FOUNTAIN <br />FLOOR GRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />PARCEL TAX I.D. N <br />Z �f0.5�1GYI3 /0?1�0 <br />THACT <br />/4 n9-2/._r,iJ <br />�w �oy-�3 <br />o�-�� <br />""""'��I�oS. L/es,►c.uehs nP PHONE <br />�P • #� zov <br />/� � rP,�S n/A- 951'2s� SlZ6 33c1_o� <br />CONTACTNAM PHONE <br />�'i� �,IK.IP/'� sar� �/ YZs-335'-Gi5l� <br />A�'EV'it.l�5���.VeY45F�'��P C ���'fi/�l� <br />-ns W.� 9 gzss� y4. <br />Building Mechanical <br />PERMIT omh�^alion R Plumbing <br />TYPE Demolilion p Sign <br />Sprinkler <br />n Addition HEAT SOURCE <br />I--S Alteration Eleciric <br />�F New Gas <br />IJ RepaiqMainl. Other <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />�� �sr��o °�/ i 3 <br />NO. I TYpE OF PI%TURE OR ITEM <br />rvc — wn,arvULING UNITS <br />�, FORCED AIR SYSTEMS <br />= HEAT PUMP <br />= UNIT HEATERS <br />._(_ CLOTHES DRYER <br />_ RANGE HOOD <br />,L_ WATER HEATEF <br />_ METAL FIREPLACE/STOVE <br />FIREPIACE INSERT <br />= GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />� OTHER <br />z <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED?HIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF IAWS AND ORIDINP.CES GOVERNING THIS TYPE OF WOFK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN Oq <br />NOT. THE GRANTII�G OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY O7kiER � <br />STATE OR LOCAL LAW REGUTATING CONSTqL'CT10N OR THE PEAFORMANCE OF CONSTfiUCTION. THAT I AM AUTHORIZED BY TfIE <br />OWNER OF THIS PROPERN TO PERFORM THE WORK FOR WHICH APpLICATION IS MADE AND I COMPLY WITH THE STATE <br />CON^RACT�o1LJ�18.27 RCW AND 296.200 WAC. <br />