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� <br />� <br />�ERMIT APPLICATiJN <br />CITY OF EVER�7T PERMIT SERVICES <br />3200 CEDAR S REET, EVERETT, WA 98201 <br />425-257- 810 - FAX 425-257-8857 <br />SITE ADDRESS STE. �4. <br />$oZ. S6 tvt'rtG2e�v Iuwy <br />LEGA LOT NO. BLOCK <br />PARCEL TAX I.D. # <br />26o�1a - 003 -070• o0 <br />TRACT <br />PERMIT 1t <br />TENANTNAME CONTACTNAME PHONE <br />�Ve�GR�r�nl �*,2$�7t �Qe-rtNryy oun, �?e-np y (2D6i 36i-oo7i <br />CONTRACTOR �"��� AODRE55 ZIP CONTR. LICENSE q <br />pRo - s r+F� r•��cEr-q,nii ugL yo 8vk 3?3 � o St�'ffT�tt 9813; <br />361 -oo7i <br />PROPOSED USE OF BUILOING <br />Building <br />PERMIT g Combination <br />TYPE D Demolition <br />U Sprinkler <br />CONTRACT PRICE OF WORK ��, 9 OD, 00 <br />Plumbing <br />Sign <br />Addition <br />Alleration <br />New <br />Repair/Maint. <br />HEATSOURCE <br />�Iectric <br />as <br />Other <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />WORKDESCRIPTION i�S+Q�( qc�,.' /'JnFfp�o 'qJ ��piny ffdM �7Gt� MGIt✓ '�• Qx�Jti�l� <br />C_ <br />hca.��9 �wH,�'f St✓V/Nr� E'VG✓'9/C�n R9rbw %��'t 4n�� iI C«�'>'�nf/y .IEwCd <br />hr QKo�� ,����,., <br />NO. I TYPE OF FIXTURE OR REM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />� _ KITCHEN SINK & DISPOSAL <br />i _ DISHWASHER <br />; _ LAUNDRYTRAY <br />( _ CLOTHES WASHER <br />URINAL <br />• DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAF/MOP/ETC.) <br />OTHER <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT 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 />EXHAUST FAN <br />OTHER <br />I HEREBV CERITIFY'HAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. A�L <br />PROVISIONS OF LAlNS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHEfHEfl SPECIFIED HEREIN OR <br />NOT. THE GFAtJTING OF A PERMIT DOES NOT PFESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STAT'e OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT � AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW iB27 RCW AND 296.200 WAC. <br />SignaWre of OwnevConiractor/Authorized Agern Date <br />