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F� �RIVIIT APPLICATIvN <br />CITY OF EVERETT PERMIT SERVI�ES <br />3200 CEDAR STREET, EVERETT. UVA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRESS <br />i�y/ SE EvE�ETr MA[-�. w�y <br />LEGA LOT NO. BLOCK <br />oesc. .SE& ca�E,� sy TI.O <br />6DA KEA� ESTFITE ,�,��vic� <br />TENANTNAME <br />Go<o57t�NE �RE�IMEK`/ <br />Y���_ <br />PARCFL TAX I.D. � <br />ZSoS/d oo yo y5o� <br />TRA�T <br />PEFMIT d <br />Ba3o�- a3� <br />MVVIICJJ e��� • ��v��r <br />B3o/ �• P,eF-�v7�E A✓E. ��i/� 3a3. ZZ/. SSoo <br />'virE' Zio GREE�/wao� VictAGE� Co. _ <br />CONTACTNAME <br />vicKi �oMPP/ <br />PHONE �r,io <br />`f.Z5.67o.6�a6 / <br />CONTRACTOR ADDRESS ZIP CONTfi. LICENSE a <br />�nv�s s�/�uct�E� ?/1Z -/6`/:H sr. Sw, z j�AVis�L/oSPN <br />PHONE Svi� Zoo � S'NNhAOD, wA. %���� �p 7_�_ oy <br />PROPOSED USE OF BU�L�ING <br />/�ETA�L <br />Building <br />PERMIT � Com6inalion <br />TYPE Demolitinn <br />Sprinkler <br />COMAACT PHICE OF WORK � BjrOO. OO <br />Mechanical <br />Plumbing WORf <br />Sign TYPE <br />� Addition <br />Ihlleration <br />�_� New <br />LJ RepaidMaint. <br />HEATSOURCE <br />�Electric <br />Gas <br />Oiher <br />CITV OF EVERETf IOCHL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />/1%Ew TE.tiFINT 7JEMiSin�G WA[.[., M�DiFY ctG. GPiD. �PELoc,aTE LAMPS, P�P�v�oE NEH/ <br />ADA �YEs>,eoprj, <br />NO. � TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />EATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSA� <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />_ SINK (SERVICE/BAR/MOPlETC.) <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIFi SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPIACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ ANO EXAMINED THIS APPLICATION AND KfJOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF W WS AND ORIDINACES GOVERNING THIS TYPE OF WCRK `NILL BE COMPUED WITH WHETHEF SP'cCIFi'cD HEREIN OR <br />NOT. THE GRANTING OF A PERh11T DOES NOT PRESUME 70 GIVE AUTHOAl1Y TO VICLATE OR CA�CEI. THE PROVISI6fV OF ANY OTHEF <br />STATE OR �OCAI LAW REGULATING CONSTFUCTION OR THE PERFORMANCE OF CONSTfiUCTION. THAT I AM AUTHORIZED 8Y THE <br />OWNER OF THIS PROPERN TO FcRFORM THE ORK FOR WHICH APPLICATION IS htADE AND I CO\1PLY WITH THE STATE <br />CONT ACTORS LAW 18 RC A�96 00 C. <br />`\ , .'-.�/ a,� <br />Sign e ol Owner/Contractor/Authorized Agent Daie � <br />i� <br />