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� <br />PERMIT APPLIC/�TION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS PARCEL TAX I.�. # PERMIT { <br />2 �Uv'�_�'/`� <br />L[GA LOTNO. BL K TRACT <br />DESC. <br />OWNER \,uM� 110 � WRESS ZIP—_ PH10+N` � wa <br />7 f� r� <br />t'...y. 'f7sa.1 �2S �.i�GiC� 111Gtavwa.� � �$Ac� � <br />TENANT N ME CONTAC FOR P RM T PHONE <br />�_ �°hv's.' �L, �'r�'^� ��y tl.i2�\ .�, 2 I - '77/ n <br />t..r �.,n.� , �: <br />CONTRACiOR <br />PHONE .ld.l; �� 17 <br />- I '" <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />� h�� ��ODR� �1 �� , �� �, ZIP CONTR. LICENSE { <br />Z1p-/ Oti1 f.u/�. �� � _. <br />ITYPE'T � Sp nkleo1n n� Sign b n9 I I� EK � Repa dMalnL I HEA� O��c <br />CITY OF EVERETT LOCAL SALES TAX CODE IS �105 <br />J�n��l � L`.�c��S�r-rG� '�rl�=cr ���I+-�G 6�I�N <br />NO. � TYPE OF FOCTURE OR ITF41 <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (W,�SH BASIN) <br />SNOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FQUNTAIN <br />FLOOR DRAIN <br />BACKFI.OW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />NO. � TYPE OF FIXTURE OR ITEM <br />� <br />PJC - A/HANDLI NG UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATc'R HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLAC[ INSERT <br />GAS FIREPIACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND F>CAMINED THIS APPLICAT N AND KN�JW THE SAME TO BE TRUE AND CORRECT. A�L <br />PROVISIONS OF LAWS ANU ORIDINACES GUVERNING THIS TYPE O K N1LL 0E COMPLIED IMTH WNETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PER S NOT PR SUME AU ORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATF OR LOCAL LAW REG TIIJG TRI, TH E RM4NCE OF CONSTRUCTION. THAT I AM AUTHORIZED 8Y THE <br />OWNER OF THIS ROPE TO P ORM H K FO I APPLIf TION .'v1ADEAND I COMPLY IMTH THE STATE <br />ONTRACTf3RS W .27 F .W'l� 296. . <br />, .�` ! c� <br />Signatureo(OwnerlCOqt� r/ ut onzetl te / <br />�a"'�`� �L' L��' '' DEBIT REDIT CARDS ARE NOT ACCEPTED I <br />� �oM��,}t�o� <br />E,_ ^ � -^,_;,_' � � <br />rlo, I N'SIGJ.J /�'^%.� L C� � <br />rJ�^-. I�`IG�I(-�^� 1 <br />