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SITE ADDRESS <br />LEGA LOT N0. <br />DESC. <br />OWNER <br />�' 1-� <br />TENANTNAME <br />�% 11 E <br />CONTR�4CTOR <br />PHONE �\ � F <br />7 <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-6810 — FAX 425-257-8857 <br />5� <br />BLOCK TRACT <br />ADDqE <br />�� ,.. , � <br />- d5�-��5 <br />PROPOSED USE OF BUILDING <br />CON7RACT PqICE OF WORK <br />WORK DESCRIPTION <br />NO. � TYPE OF FIXTURE OR REM <br />_ WATER CLOSET (TOILET) <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 PREVENTER <br />_ SINK (SERVICE/BAR/MOP/ETC.) <br />_ OTHER <br />PARCEL TAX I.D. M <br />CONTACTNAME <br />ADDRESS <br />Building Mechenical <br />PERMIT Combination � Plumbing <br />TYPE Demolition Sign <br />Sprinkler (u ol heatls) <br />PERMIT A <br />Mo3o I-�3°� <br />LP PHONE <br />T Z►a _� -��`1-355 � <br />PHONE <br />LP CONTR. LICENSE N <br />Addition <br />Alteration <br />New <br />Repair/Maint. <br />I <br />HEATSOURCE <br />Elearic � <br />Ges � <br />fhher <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />N0. � TYPE OP FIl(TURE OR ITEM <br />� <br />A/C—A/f{qNDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAPdE TO BE TRUE AND CORRECT. ALL <br />PROVISIC�NS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHE7HER SPECIFIED HEREIN OR <br />NOT. TFic GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OH THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 8Y THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE S7ATE <br />C�RACTORS LAW 18.27 RCW APJg296200 WAC. <br />