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SITE ADDRESS <br />-_�l�p SL- C�IC-�.1 <br />��;:.�; �or�+o. <br />. <br />L.� jl .I <br />PE��MIT APPLICATIO�� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAP. STREET, E`JEP.ETT.'.NA 9z201 <br />-125-257-E810 - FAX -125-257-8857 <br />,nA� Wti`� I <br />BLOCK � TRACT <br />PARCEL TN( I.D. # <br />7-v <br />� <br />. _ . .. __ _ _.-.. . . _ _ _ <br />. OWNER --- -- .. .. .. .. . . _ ..AUDRE55. . .._.. -- �-- -- - �---- -- ZIP PHONE <br />�12s- z�io -- (,y�(e , <br />' Titc �-�-c..-ca�cna C� O� Po1- 7 � lo � CVC eL-'�' M/ku, W A �t `� 2 U$ <br />' TENANT NA�dE ; CONTACT FOR PERIdIT � PHONE ' <br />m <br />4 <br />CONTRACTOR <br />�t�=� ;, � Lsrv S'�- s � G—/`^S <br />PHONE <br />z�c, � z C�2 - 2acy <br />�3 cTt.c-N�u G�u.� i�C-�2,- <br />ADDRESS <br />�(.�U�„ 1:2S�:l�A pl. S <br />?�, --zcoz-za�y <br />ZIP CONTR. LICENSE X <br />�(`�ji U`u <br />! U <br />� PROPOSED USE OF BUILDING Duildiny Wecha�iical � Addiiiun HEAT SOl1RCE � <br />' I PERMI7 � Combinalion R Plumbing WORK � Hib::rauen r) Eleccric j <br />TYPE Demolition �:.Siyn I7YPE Ne�v �� Gas � <br />i Sprinkler Repairil.taint, b Other I <br />�., CONTRACT PRICE OF WORK � C'j � 1 1��' "—" CITY OF EVERETT LOCAL SALES TN( CODE IS 3105 ii <br />i �1 <br />i WORK OESCRIPTION ' <br />�ti:s-►�� a�e- s�r oF oiM�..�s,�.u� ���-�-szs CKz.e,—M) w,,-�4 n(Fun, l3iCei?i[. <br />� •i �W£S�� �' f. �. ; <br />I ltit�M�L O��.L " �^ .. <br />I �r.' �:,4��- o�, � �/F wR�� 5 �v� � <br />NO. I NPE OF FIXTURE OR ITEh7 <br />i WATER CLOSET (TCILET) <br />j BATHTUB <br />LAVATORY (�VASH BASIN) <br />SHOVVER <br />'�� _ KITCHEN SINK 8 DISPOSAL <br />; DISHINASHER <br />' LAUNDRY TRAY <br />j CLOTH[S WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DP,AIM <br />BACf<FLOW PREVENTER <br />� � SINK (SLRVIGEiBAR!NOP!ETC.) <br />_ .I UTHER___ <br />NO. I TYe E OF FIXTURE OR ITEM <br />A/C — PJHANDLING UNITS <br />FORCED AIR SYSTEtiIS <br />HEAT PUtiiP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />�dETA� FIREPLACE/STOVE <br />FIREPL,ICE INSERT <br />GAS FIR[PLACG <br />�AS RANGE <br />G/�S PIPING <br />_ EXHAUST FAN <br />_ OTHER <br />� i,=REBY CERIT�FY THAT I HAVE READ AfvU E.�G,` MUJED ThIS APPIICATION AND KNOW THE SA�1E TO BE TRUE AND CORREC'. ... <br />'::� �VISIONS OF L4lVS ANU ORIDINACES GOVERNING THIS NPE OF 6VORK'A9LL BE COt.1PLIED VJITH WIIETHER SPECIFIEO �-�,_ �.�' ,. <br />.:��T. THE GRAIJTING OF A PER�11T DOES tJOT ?RESUME TO GIVE.SU fHORITY TO VIOI.A�I'E OR CANCEL THE PROVISIOh GF :�'. �� �5R <br />. T;TE OR LOC'rL W:V REGUL4TING CONSTRUCTION OR THE PERFORM1IANCE OF CONSTRUCTIOFI. THAT I At.1 AU(HORI�E"? .� - <br />�:h r�JER OF THIS PROPERTY TO PERFOR61 THE 1'VORK FOR WHICH APPIICATION IS ".1F,D'c PtJD I COS'PLY VVITH TH'c STA7E <br />�;:;NTRACTORS LAW ?8.27 RC�N hND ?9a"..^.00 WAC. <br />:drtnature of Ov✓nerContractori+uthonze�i Agent Date <br />DEBIT & CREDIT CARDS ARE NOT ACCEF'TED <br />��L <br />