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� <br />� <br />LOT NO. <br />M�T APPLICATI <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />BLOCK I TRACT <br />PARCEL TAX I.D. M <br />u�rncn � <br />;�p�f'a , p,dp� r`� ( Sa3o lf�v <br />TENANTNAME I CONTACTNAME <br />CONTRACTOR ADD ESS <br />(,cJ'r�l�SourlcJ �o�s��43 ��SP,�IR� <br />PHONEy� hys"�3p�0 � <br />pROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION A/L—� <br />/� <br />P.'RMIT <br />TYPE <br />NO. � TYPE OF flxTURE OR REM <br />WATER CLOSET <br />BATIiTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEtJ SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />�� <br />PEF;MIT M � <br />Xrvrol -oo <br />/g�3 <br />PHONE <br />Z1P CONTR. LICENSE M <br />�rZ c-l�A+o�f d5 yG'vzb <br />RBuilding MecheniCal Adtlilion F1EAT SOURCE <br />Combinalion Plumbing WORK R Aiteration D Etectric <br />BOemolilion � Sign 7vPe D New D �as <br />Sprinkler � Repair/Mairn. U Olher <br />CITY OF EVEREIT LOCAL.SALES TAX CODE IS 3705 <br />� <br />NO. I TYPE OF Fl7(TURE OFl ITEM <br />A/C — AIHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATEFS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAI FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RAN3E <br />GAS PIFiNG <br />EXHAUST FAN <br />OTHER <br />I HEREBY CEFi'!FY THAT I HAVE READ AN� EXAMINED THIS APPLICATION AND KNOW THE SPME TO BE TRUE AND CORRECT. ALL <br />PPOVISIONS OF LAN'S AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHEFi SPECIFIED HE('�L•IN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PFOVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TNE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZEO BY THE <br />OWN THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MAOE AND I COMPLY WITN THE STATE <br />C ACT S LAW }6.2y yR �AND 296.200 WAC. <br />� �. % , �%/� / .. `� - Q �Z_ <br />