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P�..;MIT APPLICATIG.J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVEAETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS PARCEL TAX I.D. R I <br />5 I I(� C,o�6� AVE. 9�zo� 3i 2905- y- 025-000 .�� <br />LEGA LOT NO. BLOCK TRACT ♦ <br />DESC. <br />OWNER ADDRESS ZIP <br />ToH�1 „6R�AI.I` DW`{�R Slllr GOL.6Y AV6 EVEREIT WR, q$203 <br />M <br />339 -Lz95 <br />TENANTNAME CONTACTNAME PMOHE <br />ToNnl °�3RIqn�'' DWYE�z �lm� y25 339 -2295 <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE � <br />PMONE SEL� <br />PROPOSED USE Of BUILDING <br />�Arvavc��s�- oP Y <br />CONTRACT PRICE OF WORK <br />�j Buiiding n Mechanicai <br />PERMIT I S Combination I� Plumbing <br />TYPE � � Demolilion � Sign <br />D Sprinkler <br />�Addition <br />Alterallon <br />New <br />ReoairRdaint. <br />e����� <br />CITY Of EVEREIT IOCAL SALES TA7( COUE IS J105 <br />WORKDESCRiPnoN r�����- rL�-�- �� �� J3f�y� Hp�c O�' CXISYING GA2qGE� <br />fZ�PA12 wALL 5� orJ 3/y✓I,� AND R6�LflG6 FLAT RCx� W I7N PITGhEp T{pCI �' <br />'ib MA'1�GH ��b►�I1 fiA1_1= oF Gi1RJiC� <br />NO. TVPE OF FlXTURE OR REM <br />WA R CLOSET <br />8AT UB <br />_ LAVA RY (WA BASIN) , /� <br />SHOW iv <br />KITCHE INK DISPOSAL <br />_ DISHV'�'AS R ����'7)���. <br />LAUN:JRY T Y <br />CLOTriES WA HEA <br />URINAL / <br />DRINKING �OU AIN <br />FLOOR DRAIN <br />SINK <br />.) <br />NO. I TYPE OF FlXTURE OR ITEM <br />� <br />� <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP • <br />UNIT HEATERS <br />CL01 riES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAI. FIREPLACE/STOVE <br />FIFEPLACE INSEFiT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTNER <br />I HEFEBY CERITIFY 7HAT I HAVE READ AND EXAMINED THIS APPUCATION AND KNOIV THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVER�ING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETMER SPECIFIED MEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO G�VE AUTHOfiITV TO VIOUTE UR CANCEL 111E PROVISION OF ANY OTHEF <br />STATE OR IOGAL LAW REGULATING CONSTRUCT�ON OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZE� BV THE <br />OWNER OF THIS PROPERTY TO PEPFORM T �IE WORK FOR WHICH APPLICATION IS MADE AND i COMPLY WITH THE STA7E <br />CONTRACTORS LAW 18.2�W AND 1�96.200�VI�C. <br />