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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8357 <br />SITE ADORESS P CEL TAX I.D. # <br />_ Z{nIS f�o�li �}-Ue Do�lp2y(o/36o�O�U <br />l0T NO. <br />��=� f}l/�4'h <br />;ENANTNAME <br />/h-4 � �/+-r r <br />BLOCK I TRAC7 <br />ADDRESS <br />alo��� C-�'o�T-p�E <br />IGONTAGTFORPERMIT <br />Q'(f1d(�-P �4,�lFzj /�Pi- <br />`�J4`ST�iRi n5� �'`tie'r9i <br />PHO�'� ��_`��J <br />�r <br />PROPOSEn USE OF BUILDING I <br />PERMR <br />nre <br />GONTRACTFRICEOFWORK rDO� �� <br />� <br />PERMIT # <br />�Zo/ �fzs-3o3: <br />PHONE <br />ao� 2�d-Y7�v <br />ADDRESS <br />a¢G o �'i2�md�t� <br />Q�� �Ol �/ <br />n Building <br />n Corrhina6on <br />Boam�ruoo <br />Sprinkler <br />Sign �TVPE <br />ZIP CONTR. LICcNSE N <br />L� �-J'�l��,d'q7/a%� <br />f") Additlon I HEATSOURGE <br />bYei��pon s�-'tric <br />�_( Now <br />Gas <br />�> RepairlMaint 01her <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS J705 <br />WORK DE3CRIPTION <br />C�as to C�� � �c,�.�--�- �i.�-�� cG�n� <br />NO. I TVPE OF FIXTURE OR ITEM <br />WATER CI.OSET (TOILET) <br />— anrr�rue <br />LAVATORY (JJASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />_�LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />PLOOR DRAIN <br />BACKFLOW NREVENTER <br />SINK (SERVICE/6AWA10P/ETC.) <br />OTHER <br />NO. � TyFE OF iIXTUR� OR ITEM <br />P/l. — NlI1ANULIfVG UN ITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CIOTHES DRVER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACFJSTOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />i HEREBv CERITIFY THAT I HAVE READ AND EXAMINED THiS APPLICATION AND KNOW THE SAME 1'O BE TRUE AND CORRECT. ALL <br />FROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OF WORN WILL BE COMPUED WITH WHETHER SPEpFICD HEREIN OR <br />NOT. THE 4RANTI'VG OF A PERM1IIT DOES NCT P(iESUME 70 GIVE Al1THORITV TO VIOLATE OR CANCEL TNE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATIYG CGNSTRUCTIGN nR THE PERFORMANCE OF CONSTRUCTION. Th;AT I AM AUTHOR12ED BV THE <br />OYJNER OF iHIS P ERTY TO PERFORM THE WORK FOR WHICN APPLICATION IS MA�E AND I COMPLI' WITH TME STATE <br />CONTHp�TORS l .27 RCW AND 296.2�0 YJAC. . <br />�Z.l� ��a �2�� <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />?'d ;� �� =-;-i r - <br />�WOLi� I£�£T E00z-62-J30 <br />