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�- <br />PcRMIT APPLICATI `UN <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 />LEQA L07 NO. BLOCK <br />DESC. <br />OWNCR <br />TENANTNPME <br />CONTRACTOR <br />PHONE <br />PROPOSED USE OF BUILOING <br />PERMIT <br />TYAE <br />CONTRACT PRICE OF WORK <br />WORN DESCRIPTION <br />NO. � TYPE OF FI%TURE OR ITEM <br />WAT�ER CLOSET <br />BATHTUd <br />_ LAVATORY (WASH BASIN) <br />_ SHOWER <br />KITCHEN SINK.B OISPOSAL <br />DISHWASIiER <br />LAUNDRY TFAY <br />_ CLOTHES WASHER <br />_ URINAL <br />DRINKING FOUNTAIN <br />_ FLOOR DRAIN <br />BACKFLOW PREVENTER <br />_ SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />PARCEL TAX I.D. N <br />TRACT <br />ICONTACTNAME <br />ADDRESS <br />BBuilding Meohanical <br />Combinetlon � Pl�mbing <br />BDemolillon S!gn <br />Sprinkler <br />PERMIT Y <br />PHONE <br />ZIP CONTR. LICENSE I <br />Addlllon HEAT SOURCE <br />Allerelbn � Electric <br />New peg <br />Repelr/Mainl. Olhe� <br />CITY OF EVERETT LOCAL 3ALE8 TA% CODE IS 3f05 <br />NO. � TYPE OF FlXTURE OR ITEM <br />/vl: — A/FINIVULINf3 UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES ORYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />OAS FIREPLACE <br />GAS RANGE <br />GAS PIPIN6 <br />EXHAUST FAN <br />OTHGR <br />I HERE�V CERITIFY THAT I HAVE REAJ AND EXAMINED THIS APPLICATION AND KNOW THE SAM[ TO BE TRUE AND CORREGT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIE� WITk1 WHETNER SPECIFIE� HEREIN OR <br />NOT. THE GRANTING OF A PE9MIT DOES NOT PRESUME TO 61VE AUTHORITY TO VIOUITE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTFUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV TNE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WIiH THE STATE <br />CONTRACTORS LAW 10.27 RCW AND 298200 WAC. <br />ignatura o wner/Contractor/Authorized Agent ele <br />