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P�RMIT APPLICATIVN <br />CITY OF EVERETT PERMIT SERVICE� <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADOHESS <br />i in � <br />LEGA LOT N0. BLOCK <br />DESC. <br />OWNER <br />1'., _l��-_r�� f_��,-�ou�1 <br />TENANT NAME <br />CONTRACTOR <br />PHONE (,'h,V1�"EC` <br />PROPOSED USE OF BUILUIN(i <br />��pl�x <br />CONTV.. :T PRICE OF WORK <br />WORK DESCRIPTON <br />r�e r,la.c�e._ <br />PARCEL TAX I.D. I <br />TRACT <br />�I ISS- I I� 01� �.5� `,� <br />CONTACTNAME <br />Building Menianical <br />PEFMIT Combinelion Plumbing <br />TYPE Dernolillon Sign <br />Sprinkler <br />PERMIT N <br />I �G2G-1- <br />PHONE <br />�7.� ?��Si �� � <br />LP CONTR. LICENSE I <br />�Atl4ilion <br />Allarallon <br />New <br />Rnpair/Maint. <br />HEATSOURCE <br />Electtic <br />Oes <br />Other <br />CITY OF EVERETT LOCAL SALES TA;( COOE IS 3105 <br />\ 1� <br />wn��21'�in�e. �n m<vh �o r�ouSE <br />NO. � TYPE OF Fl7(TURE OR REM <br />! WATER CLOSET <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 />FLOOF DFAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTH�u�r <br />. <br />YO. I TYPE OF FI%TURE OR ITEM <br />A/C — AIHANDLING UNITS <br />FOFCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATEHHEATER <br />METAL FIREPLACESTOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />OAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER __ <br />I HEREBY CEFITIFV THAT I HAVE READ AND EXAMINED THIS APPUCATION AND KNOW THE SAME TC 11E TRUE AND CORqECT. AlL <br />PF70VISIUNS OF LAWS AND ORIDINACES GOVERNING THIS IYPE OF WORK WILL BE COMPLIED WITH LYHEfHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT OOES NOT PFESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />SiATE OR LOCAL LAW REGIiV+TIN(: CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAi I AM AUTMORIZED BV THE <br />OWNEF QF THIS PROPERN TO PERFORM THE WORK FOR WNICH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTR�CTORS�LAW 18.27 RCW AND 298.200 WAC. <br />