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� <br />P .:RMIT APPLICATI�N <br />CITY OF EVERETT PERlIAIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425•257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />LEGA LOT N0. BLOCK <br />DESC. <br />OWNEH <br />TENANTNAME <br />CpNTRACTOR <br />PHONE <br />PROPOSED USE OF BUILDING <br />PERMI7 <br />TYPE <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />N0. � TYPE OF FIXTURE OR �TEM <br />_ WATER CLOSET <br />BATHTUB <br />_ LAVATORY (WASN DASIN) <br />_ SHOWER <br />_ KITCHEN SINK.B DISPOSAI <br />_ DISHWASHER <br />_ LAUNDRYTRAY <br />CLOTHES WASHER <br />_ URINAL <br />_ DPINKING FOUNTAIN <br />_ FLOOR DRAIN <br />BACKFLOW PREVENTER <br />_ SINK (SERJICE/BAR/MOP/ETC.) <br />OTHER <br />PARCEL TA% I.D. I <br />TRACT <br />CONTACTNAME <br />ADDRESS <br />BBuilding <br />Combinelion <br />BDemollllon <br />Sprinkler <br />Mechenlcal <br />Plumbing <br />Slgn <br />PERMIT d <br />PNONE <br />� LP CONTR. IICENSE N <br />Addltion HEAT90URCE <br />Alteretlon Electric <br />New Oae <br />RBpairlMelnt. Olher <br />CITY OF EVERETT LOCAL SALES TA% COOE IS 3105 <br />NO. � TVpE OF FlXTURE OR REM <br />,_ N[: — NHANDLIN6 UNITS <br />_ FORCED AIR SYSTEMS <br />_ HEAT PUMP <br />_ UNIT HEATERS <br />_ CLOTHES DRYER <br />_ RANGE HOOD <br />_ WATER fIEATER <br />_ METAL FIREPLACE/STOVE <br />_ FIREPLACE INSEFT <br />_ OAS FIREPLACE <br />_ OAS RANC3E <br />_ OAS PIPINO <br />_ EXHAUSTFAN <br />__ OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND COP.RECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES dOVERNINa THIS TYPE OF WORK WiLL BE CGMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PEPMIT DOES NOT PRESUME TO 61Vc AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT i AM AUTHORIZED BY THE <br />OWNEP OF THIS PROPERTY TO PERFORM THE WORK FOF WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW ANO 298200 WAC. <br />Signalure o wner/ ontreclor uTi�tharized genl ate <br />