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SITE ADDRESS <br />�la 10 5� <br />LEGAL� LOT NO. <br />DESC.r Z C�E <br />JFM�S <br />TENANTNAME <br />F��RMIT APPLICATI��I <br />CITY OF EVERET7 PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />PARCEL TAX I.D. # <br />t�� wa 18 ,8 0�3 085 <br />BLOCK TRACT <br />r�•a <br />A�DRESS <br />• Two �N�oA cS�w�,/1� �ot <br />I CONTACT NAME n_. I. i <br />CONTRACTOR n ///'''��� <br />PYONE �D v � <br />PROPOSED USE OF BUILDING <br />Occ,uVAN°Y F� <br />ADDRESS <br />.• <br />f� Building Mechanical <br />PERMIT H�j� Combi; at�on Plumbing <br />TYPE �y Demolition Sign <br />U Sprinkler <br />CONTRACT PRICE UF WORK ,� yQ �n � <br />�/O <br />PERMIT M <br />g �3d �-d3 5 . <br />10NE ZO(�.223.�Lb <br />S�tA.E' 98to�1 <br />10N�a5ln�o-(o� �v <br />1:-3�33�!!Y <br />���uc�s�e% / <br />Addition <br />WORK Alleration <br />TYPE New <br />Repair/Maint. <br />HEATSOURCE <br />Electric <br />Gas <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />WORK DESCRIPTION <br />T�Enta�vi �Mr'/��e"��r —Otw.o�tno•.l � �tt,0•o�r oF !�IEw oFP,c.ES <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />O�SHWASHEFi <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACK.FL�W PREVENTER <br />SINK (SEI3VICEl6AR/MOP/ETC.) <br />OTHER_ <br />NO. I TYPE OF FlXTURE OR REM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />N�ATER HEATER <br />MCTAL FIREPLACE/STOVE <br />FIFIEPLACE INSERT <br />GAS FlFiEPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I H�REBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TPUF AND CORRECT. AlL <br />PROVISIONS OF L.FlWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMFNCE OF COtJSTRUCTION. THAT I AM AUTHORI�ED BY THE <br />OWNER OF THIS PROPER7V TO PERFORM THE 6VORK FOfl WHICH APPLICATION IS MADE AND I COM17PLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />U/J�.�G�`ry i�'�'1 1�. 2 f d�j <br />Signature ol O�y er/Contrador thorized Agent Date <br />/Ci.. <br />