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PC,�NfIT APPLICATIC_ � <br />CITY OF EVERETT PERMI�' SERVICES <br />3200 CEDAR STREET, EVERETT, W.4 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE AD�RESS <br />z3�3 I�o �Ct�... tzD <br />LEGA LOT NO. BLOCK <br />DESC. �� <br />UWNER <br />�l U�l�Vt� i-i- �AU l'�or�.J <br />TENANT NAME <br />Lu( LLI1�vbl O D,4Ul�l.� <br />cor�aacroa <br />�1�—� <br />PHONE <br />PROPOSED USE OF BUILDING <br />s V= (� <br />U2G�(-0I y <br />PARCEL TAX I.D. k <br />oo5oc� �� !/ cz> � , _ <br />TRACT <br />l._oU.��(� UlG,�7 1lz,:GT-s <br />ADDHE55 ZIP PHONE <br />� �k � V 1�`��` ��. � • �125 L�) �?� �� <br />I CONTACT NAME PHOPIE <br />'(�vt (L <br />aooaess <br />Building Mechanicai <br />PERMIT Combination � Plumbing <br />T'PE Demolition Sign <br />Sprinkler <br />CONTRACT PRICE OF WORK �� . <br />Z�P CONTR, LICENSE N <br />Addition �'EATSOURCE <br />WORK � Alteralion Electric <br />TYPE New � Gas <br />/tr, Rapair/MainL U Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WOIiK DESCRIpTION <br />t��A� rL 19.�u. �- �jc l�ttc.� c�{�{ �'�?�i kl�� � rr(� l� <br />NO. I TYPE OF FIXTUflE OR ITEId <br />WATER CLOSET <br />BATHTUP <br />LAVATORY (WASH BASIN) <br />SHC'YER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWrSaHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING F7UNTAIN <br />FLOOFi DRAIN <br />BACKF�JW PREV':NTER <br />SINI< (SERVICE/BAFi,'I�tOP/ETC.) <br />OTHER <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ 'v�—wnArvULINGUNITS <br />_ FORCED AIR SYSTEM5 <br />_ HEAT PUMP <br />_ UNIT HEATERS <br />_ CLOTHES DRYER <br />_ RANGEHOOD <br />WATER HEATER <br />_ METAL FIREPLACEiSTOVE <br />_ FIREPLACc INSERT <br />_ GAS FIREPLACE <br />GAS RANGE <br />_ GAS PIPING <br />_ EXHAUSTFAN <br />_ OTHER_�_ <br />I HEREBY CERITIFY THAT 1 HAVE READ AND EXAMINED THIS APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF IAVyS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A pERMIT OOES NOT PqFSUME TO GIVE AUTHORITY TO VIOL4TE OR CANCEL THE PROVIS�ON OF ANY OTHER <br />STATE OR LOCAL LAW qEGULATING CONSTRUCTIqN OR THE PERFORMANCE OF CONSTRUCTIOIJ. THAT I AM AUTHORIZED BY THE <br />O�t^T�;�y� �SLA'�jl�PB 27TM W ANDF 96 7�00 WA��RK FOP. WHICH APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br />/11� � � I <br />