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PEF��rIIT APPLI�ATION <br />r CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257•8810 - FAX 425-257-d857 <br />SITE ADDRESS <br />i� 3 " `/ <br />LEGA LOT N0. <br />�� I- �� �� <br />� BLOCK � TRACT <br />PARCEL TAX I.D. p <br />.:1 E'�Qfi�lcr� ��-3or� <br />�,z i';/j�, <br />�� � <br />PEFiM1T • <br />% i��o�� <br />Wendd! Srnrr /kNrlap, /nc y� s z��-C �+, 7U <br />Sroll Roroann • Prraident <br />TE tzp� - l/Wlh I'l�t�t .S./;: I CONTAC? VAME PHONE <br />llrrru, 14A 9X2lk1 � <br />CONTRACTOR• � ,• � <br />PHONE <br />PROPOSEO USE OF BUILOING <br />,'� �, C <br />CONTRACT PRICE Of WORK <br />ADUqESS l <br />Building Mechanical <br />PERMIT Combinalion R Plumbmg <br />7YPE Demolilion p Sign <br />Sprinkler <br />WORK OESCRIPTION /,� f / C �1 /Y ; <br />f� <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEIJ SINK 8 DISPOSAL <br />DISHWASNER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />UFINAL <br />DRINKING FOUNTAIN <br />FLOOF DFAIN <br />�ACKFLOW PREVENTER <br />SINK (SERVICEiBAR/MOPiETC.) <br />OTIiER <br />. ZIP �ONTR. LICENSE N . <br />� � , .. <br />e „�oes.p 9 � �-� � <br />' Addilion MEAT SOURCE <br />WORN � Alterolian � Electnc <br />TVPE New Gas <br />Repair/Mainl. Other <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />G��S PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERITIFV'HAT I HAVE READ AND EXAMINED THIS APPIICATION AND NNOW THE SAME TO BE TFUE ANO CORRECT. ALL <br />PPOVISIONS OF L,1WS AND ORIDINACES GOVERNING THIS TVPE OF WORK WILL BE COMPUED WITH WHETHER SPECIPFD NEREIN OR <br />NOT THE GRnNTING OF A PER1dli DOES NOT PRESUME 70 GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV OTHER <br />STATE OR LUCAL LAW REGULATING CONSTRUCTION OR THE PERFO�'AIANCE OF CONSTRUCTION. THAT I AM AUTHOPIZED BV THE <br />OWNE/i OF THIS PPOPEPTY TO PERFORM THE WORK POR WHICH APP�ICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RGW AND 296200 WAC. <br />�.- <br />