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� <br />� <br />C ERMIT APPLICAICJN <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 />� v S'� <br />LEGA LOT NO. BLOCK TRACT <br />DESC. <br />GWNER ADDRE <br />� ! /C�J l/J V! '�VG �Fl S/'{J <br />TENANT NA E �ai <br />PARCEL TAX I.D. N <br />N ME <br />Z' LY%S <br />id <br />I l'i,Un �J' <br />CONTRACTOR ADORESS ZIp CONTR. LICENSE M <br />PHONE <br />PROPOSED USE OF BUILDING <br />CONTRACT PFiICE OF WORK <br />WORK DESCRIPTION <br />i <br />� — <br />TYPE OF flXTURE OR REM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPO L <br />pISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL ^ <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />� Building Mechanical Addllion HEAT SOURCE <br />PERMIT [) Combination R Plumbing WORK � Alterellon � Electric <br />TYPE D Demolition � Sign TYPE New Gas <br />�7 Sprinkler RepaiUMainL Oiher <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 3706 <br />s <br />h<<'� <br />NO. �'�YPE OF Fll(TURE OR (TEM <br />A/C - A/HANDLING UNITS <br />FORCED AIR SYS F, <br />_ HEATPUMP �� �J�� '1.13R�i <br />_ UNIT HEATER� 0?1Z00� <br />_ CLOTHES DRYr�HLC1 �3. ip <br />_ RANGEHOODSfiCHG •. 4,50 <br />_ WATER HEATEFtn�NL '' '�j��:�� <br />_ METAL FIREPL/�C gTOVE <br />_ FIREPLACE INSERT � +' `_ � <br />_ GAS FIREPLACE <br />_ GAS RANGE A OM 6`�9 <br />_ GAS PIPING <br />_ EXHAIIST FAN <br />_ OTHER <br />C::ASi-� <br />c:h�,ia�:� <br />i HEiiEBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. qLL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHE7NE(i;S�EC�IFIED 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 />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFOFM THE WORK FOR WHICH APPIICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 FCW AND 296.200 WAC. <br />