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� <br />P�cRMIT APPLICATI�.N <br />., <br />CITY OF EVERETT PERIVIIT SE�iVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />Snnc� �'3� <br />SITE ADDRESS PARCEL TAX I.O. k PERM�7 u <br />I"I 0'Z 5���e,f'e�"i� /�lu � � U/ PV� 03 v R� G 3'-1 <br />LEGA LOT NO. BLOCK TRACT <br />DESC. <br />OWNER ` U I Q��� J, n� ADDRESS vU� � � I W ZIP PHONE <br />�L � �� lyoz sF E f y qa� (yzS�Ts5�5yyy <br />TENANTNAME <br />�eac �� V151n�✓" <br />CONTRACTOiiM�r��i- M.e�kuN(C5 <br />PHON�V' ZS� �83-�rzz �/ <br />PROPOSED USE OF BUILOING <br />P[RMIT <br />TYPE <br />CONTRACT PRICE OF WORK � ���� — <br />WORK OESCRIPTION I' l�` •� J�- <br />L)-, /�1 <br />�i��l ��^"� <br />CK�J�ci�y. <br />NO. I TYPE OF FIXTURE OR 17EM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />� KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTH[S WASHER <br />URINAL • <br />DRINKING FOUNTAIN <br />F1.00R DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />CON7ACTNAME <br />�u�5 �roh� rdf <br />AD�RESSq�?��l 153 �� / t ✓C <br />Building <br />Combinatio� <br />Demolition <br />Sprinkler <br />�Mechanical <br />Plumbing <br />Sign <br />PHO <br />�yzs i�z-3zyZ <br />LICENSE k <br />M �rzzrMz � 6 <br />Addition <br />Alleralion <br />Naw <br />Repair/Maint. <br />HEATSOURCE <br />Eiectric <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />�„� c-ti��� � o� r�+ �x-s�,�N� Pki <br />�-{I� ivew����c� ��e hekF.�Dui�� o� e�"`` ��y. <br />/�c�a )- tm en;s „�.� �.urb w,+c, fl�ru t� -c�r <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED P.IR SYSTEMS <br />__�__ FIEAT 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 />EXHAUSTFAN <br />_ OTHER <br />I HEREBY CEFITIFY THAT I HAVE REA� AND EXAMINED THIS APPLICATION AND'KNOW THE SAME TO BE TRUE AND CORRECT. ALl <br />PAOVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GPANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORiN TO 410LATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW FEGULATING CONSTRUCT�ON OR THE PERFOFiMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER F THIS PfiOPE TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONT,RA�TORS LAW 1.27 ACW AND 296.200 WAC. . <br />