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� <br />�� <br />SITE ADDRESS <br />22Z2 <br />LEGA LOT NO. <br />TENANT NAME <br />CONTRACTOR <br />PHONE <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />�, ERMIT APPLICA�._ �N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />PARCEL TAX I.D. q <br />BLOCK TRACT <br />ADDRESS <br />ICONTACTNAME <br />ADDRESS <br />PERMIT <br />TY�E <br />�Building Mechanical <br />Combination R Plumbing <br />Demolilion � Sign <br />Sprinkler <br />WORK DESCRIPLION <br />`3 1��0� Uc�:� <br />; NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />_ LAVATORY (WASH BASIN) <br />_ SHO'.VER <br />_ KITCHEN SINK 8 DISPOSAL <br />_ DISHWASHER <br />LAUNDFYTRAY <br />CLOTHES WASHER <br />URINAL <br />GRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />_ SINK (SERVICE/BAR/MOP/ETC.) <br />_ OTHER <br />PERMIT # <br />.Qba(i <br />PHONE <br />LP CONTR. UCENSE M <br />Q Atldition HEAT SOURCE <br />�) Alteration Q Electric <br />BNew �J Gas <br />Repair/Maint. U Other <br />CITY OF EVERETT LOCAL SALES TAX COUE IS 3105 <br />NO. � TYPE OF FIXTURE OR ITEM <br />_ A/G—NHANDLINGUNITS <br />_ FORCED AIR SYSTEMS <br />,_ HEAT PUMP <br />_ UNIT HEATERS <br />CLOTHES �RYER <br />RANGEHCOD <br />WATER HEATER <br />METAL FIREPLACFJSTOVE <br />FIPEPI.ACE INSERT <br />GAS FIREPLACE <br />_ GAS RANGE <br />GAS PIPING <br />_ EXHAUST FAN <br />_ OTHER <br />I HEREBY CERITIFY'HAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE f,AA1E TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF L4WS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COh9PLIED WITH WHEfHER SPECIFIED HEREIN OR <br />NOT. THE GFANTING OF A PERMIT OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PFOVIS�ON OF ANY OTHER <br />STA7E OR LOCAL L.1W REGUI.ATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY INITH THE STATE <br />CONTRACTORS W W 18.27 RCW AND 290200 WAC. <br />SignaWre ol OwnerlContractor/Authonzed Agent Date �/ <br />