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j'ERMIT APPLICAT'�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 � <br />)�i.' •1 d� - �� <br />SITE ADDRESS � pARCEL TN( I.D,1 pEpMR � <br />ZS3/ 96 �L -sE I 9y�7-aao-ao�-oa �(bti�_,;,r <br />LOTN BLOCK TRACT <br />� _ �i�P ��,�' <br />COHTRACTOq '/ ADDHES9 <br />� /�f A��! .741K <br />PHONE <br />PROPOSED USE OF BUILDINQ <br />GONTRACT PRICE OF WORK <br />.runR uescraPnan <br />Sf� � <br />�,f� � Z�LI <br />PLUMBING <br />NO. I TVPE OF FI%TURE OR REM <br />' WA�EflGLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 6 DISPOSAL <br />DISHWASHER <br />IAUNDRYTqAY <br />CLOTHES WASHER <br />URINAL <br />ORINKING FOUNTAIN <br />FIOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICEIBAR/MOP/ETC.) <br />OTHER <br />�rs,s�.J ,r� <br />NAME <br />� Bullding <br />PERMIT Combinetion <br />TYPE Demotilion <br />Sprinkler <br />Mechenical <br />Plumbfng <br />Slgn <br />�rs-33y-as�3 <br />PHONE <br />yis-33yos7,.3 <br />ZIP CONTR. LICEMBE � <br />EG�1 �y�/� <br />�Addilion HEAT SOURCE <br />Alleraliwl n Elettrk <br />New �g Oee <br />Repair/Mainl. LJ Other <br />CITY OF EVEREIT LOCAL SALES TA% CODE IS �106 <br />NO. � TYpE OF fl7(TURE OR ITEM <br />ac - q/HqNDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMF' <br />UNIT HEATEHS <br />CIOTHES DRYER <br />RANOEHOOD <br />WATER HEAIER <br />METAL FIRFPLACE/STOVE <br />FIREPLACE INSEfiT <br />OAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CEFIi1FY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW TME SAME TO BE TRUE AND CORREC7. ALL <br />PROVISIONS OF LAWS AN� ORIDINACES GOVERNINO THIS TYPE OF WORK WILL BE COMPLI[J WITM WHETHER SPECIFIED HEREIN OH <br />NOT. THE GRANTING OF A PERMI7 OOES N07 PRESUME TO 61VE AUTHORITY TO VIOUTE OR CANCEL THE PROVISION OF ANV OTHER <br />STATE OR IOCAI. UW REGUU7ING CONSTRUCTION OR THE PERFORMANCE OF CONS7RUCTION. THqT I AM AUTHORIZED BV THE <br />OWNER OF TNIS PqOPERTY TO PFRFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONiRA�O�S L� 1B.27 AC"" ,JL 298.200 WAC. <br />Z /9-.3 <br />U'/a <br />