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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425 �57-8810 - FAX 425-257-8857 C��n <br />��1� _ .�i ir <br />SIT� 4DDRESS <br />b� 6tO�Of✓Ny1 <br />LE6A l0T NO. <br />PARCEL 7Al( I.D. � �y� <br />1iVNf�7/1� Vv4v�o53���I�WIv� <br />BLOCK ?RACT 5�7�/ $� I� 8 N�1 <br />OWNER `P}f�. `.� "a�'� LG.G <br />/3��� �►�tYR,�-,+ y� `f �Y 3 oct:�+v �N.E•, G�t�• 9�'Z ns <br />TENANTNAME CONTACTNAME <br />J�A�'.� � I ✓ct++^�f TI�.oHna.t Art-c4k <br />CON'iFACTOR <br />PMONE <br />6�E�V a��r <br />/0� 2> :; r�. <br />Ei�yci" wa <br />PROPI:SED USE OF BUILDING <br />CONTRACT PRICE f��VOR C� <br />WORK DESCRIPTION <br />ADDRESS <br />Q�ds t-z.f''.S�/-/S3/ <br />Building Mechanical <br />PERMI7 Combinelion � Plumbing <br />TYPE Demolition U Sign <br />Sprinkler <br />-' So t ,-I <br />GoN S7'7zvu��ti1 <br />7�3',� S� Wi <br />N0. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH DASIN) <br />_I !2'�TCH[N SINK 8 DISPOSAL <br />LAU RY TRAY <br />CLOT 5 WASHER <br />URINAL <br />DRINKING UNT <br />FLOOR DRA� <br />�— BACKFLOW E <br />_ SINK (SE CE/BA <br />_ OTHER <br />7I 'c/J� <br />�E IT N <br />E �Lv IU�N . <br />IONE � <br />�-z r� � S� <br />IONE <br />�Ld--L,� - v66 , <br />ZAP VV( <br />GE <br />�dditlon <br />Ilerelion <br />New <br />RepeidMai� <br />� I CRYOFEVERETTLOCALSALE <br />o� n� �� �l <br />�z., q ) 3 S�= /�A�� G <br />d� <br />ECHA� <br />I NO. I TYPE OF FlXTURE OR REM <br />NC — NHM4DLING UNITS <br />FORCED�IIIR SYSTEMS <br />HEAT PUMP <br />UNIT A'ERS <br />O ES DRYER <br />RA E HOOD <br />W HEATER <br />M TAL F P E/STOV <br />F EPLACE ERT <br />AS FIR C <br />AS R GE <br />AS IPING <br />AUST FAN <br />11YGNYG w <br />>H� �,oZ�� <br />HEATSOURCE <br />lectric <br />Ges <br />— Olher <br />CODE IS 3105 <br />t,p G . <br />G.4�Oa4G� <br />1 fiER[�Y CERITIFY THAT I I1AVE READ AND ExAMINC-D THIS APPLICATION �ND KNOW TI1E SAME TO BE TR�AND CORRECT. ALL <br />PFOVISIONS Of LAWS AIJD ORIDINACC-5 GOVERNIIJG THIS TYPE OF WORK WILL BE COMPIIED WITH WNETHER SPECIFlED HEREIN OR <br />IJOi. TfIE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHOR�TY TO VIOL/�TE OR CANCEL THE PROVISION OF ANY OTHER <br />OVJNER OF TO' IS PROi'ERTY OTPrC-R RM THE W RK POR WHICN APPMICATION IS MADE'A DTI COMPLY W TH THE STATE D DY TH[ <br />CONTFACTORS LAW 1827 RCW AND 296.200 WAC. <br />Signalure ol OwnedConlraclodAulhorized Agenl Dale 1/L <br />