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I <br />� <br />� <br />E ADORESS <br />s� n� . <br />LEGA� LOi NO. <br />DESC. <br />P�.�MIT APPLICATIG;J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />iENANT NAME <br />CONTRACTOR S _ � / <br />Q�C� <br />PHONE L/ <br />��-- ,s-E <br />_ � �� <br />PROPOSED USE OF BU�LOING <br />CONTPACT PRICE OF WORK <br />WORK DESCRIPTION �n J� <br />�y�,;lV� f l};�1/iL��J <br />NO. � TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/8AR/MOP/ETC.) <br />OTHER <br />PARCEL TAX I.D, q <br />:K TRACT <br />ADDRESS <br />g� N. ��. <br />ICONTACTNAME <br />AD�RESS <br />S�� <br />Building Mechanical <br />PERMIT COmbinali0n R Plumbing <br />TYPE Demolilion p Sfgn <br />Sprinkier <br />PERMIT q <br />13 � �q-dZz <br />PHONE <br />ZIP CONTR. LICENSE M <br />Addition HEAT SOURCE <br />Alleration R Electric <br />New �,.] Gas <br />Repair/Main1. U Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />NO. � TYpE OF FIXTURE OR ITEM <br />_ n/(: — 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 />_ GAS PIPING <br />_ EXHAUST FAN <br />_ OTHER <br />I HEREBY CEAITIFY'HA71 HAVE READ AND EXAMINE� THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORiiECT. ALL <br />PROVISIONS OF 1.:1W5 AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL EE COMPLIED WITH WHEfHER SPECIFIED HEREIN O(i <br />NOT. 7HE GRANTING OF A PERMIT DOES NUT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROV�SION OF ANY OTHER <br />STATE OR IOCAL LAW REGULATING CONSTqUCT10N OR THE PERFORh1ANCE OF CONSTFUCTION. THAT I AM AUTHORIZED BY THE <br />OWNEFi OF THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTOR AW 19.27 RCW AND 296200 WAC. <br />_ \ - lit�� �� ��0� <br />