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PL,�MIT APPLICATIG�J <br />CIiY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STRErT, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />�jSOO �VG� (tGn/ L� <br />LEGA LOT NO. � BLOCK <br />DESC. <br />/1L� _ <br />TENANT NAME <br />%.�00 ¢� <br />P. o. L•'o <br />cnl L�A v <br />CO�TRACTOR �-- <br />�Gr�y Nc�N <br />PHONE7�' ,77C� Sg3S <br />PROPOSE� USE OF BUILDING <br />f G-�� i L <br />0 <br />PARCEL TAX I.D. q <br />� 003�3 00000 �lo <br />TRAC7 <br />z 7 7 $' �v�.c, <br />ICONTACTNAME <br />S�tot I�Lo vs <br />� <br />w� <br />ADDRESS �— <br />f�o,b'o� 526�7 <br />L�^�NaiOoD� �+�'f- <br />8uilding Mechanical <br />PEaMIT R Combination Plumbing <br />TYPE D Demolilion �$ign <br />U Sprinkier <br />curvIHACTPflICEOFWORK � ZZ' �pp o_ <br />O <br />rvunn utSc;RipTION T,'� - <br />(% f�� N�ov�L �CXIS'�i2ar <br />�� i.�,s�9cc .vev � � <br />�Y ON 5 !fN <br />N�. I TYPE OF FIXTURE OR ITEM <br />_ wnrERCIOSET <br />_ BATHTUB <br />_ LAVATORY (WASH BASIIV) <br />_ SHOWER <br />_ KITCHEN SINK & DISPOSAL <br />_ DISHWASHER <br />_ LAUNDRY TRAY <br />_ CLOTHES WASHER <br />_ URINAL <br />_ DRINKING FOUNTAIN <br />_ FLOOR DRAIN <br />_ BACKFLOW PREVENTER <br />_ SINK (SERVICE/BAR/MOP/ETC.) <br />_ OTHER <br />PERMIT q <br />� S 30/-008 <br />21P PHONE <br />9 a2c3 <br />PHONE <br />�Jzs= ��6-�3 3s- <br />Z�P CONTR. LICENSE q <br />�O!{C 'gGrrY•V� o �7t /n <br />Addilion I HEAT SOURCE <br />WOHK Alleration Q Electric <br />TYPE ew �] Gas <br />RepaidMaint. U Olher <br />CITY OF EVEpETT LOCAL SALES TAX COOE IS 3105 <br />�"loN .SrqN <br />i ., <br />NO. � TYPE OF FIXTURE OR ITEM <br />_ A1C–A/HANDLINGUNITS <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 THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PFOVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GfiANTING OF A PERMIT �OES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />S7ATE OR IOCAL LAW REGULqTING CONSTRUCTION OR THE PERFOflMANCE OF CONSTFUCTION. THAT I AM AUTHOF�ZED BY THE <br />OWNER OF THIS PROpER TO PERP � THE WORI( FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE TE <br />CONTRACTORS LAW 1 � <br />Sig of nedContractoqAulhorized Agent Date �// <br />, \ �V <br />U� � <br />� 1 `/� <br />