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IT APPLICATIO <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />�J`��o ��%l� <br />SITE ADDRESS PARCEL TAX I.D. • ��� • <br />L-r'id7 f'��w''`� 593(0 4s5 06� 000Z C�IIt-�2�� <br />oes�c. �or ra. s�xK rnncr ��//`„� //s Z" � <br />-� �s S <br />OWNER ADOR / / IIP// �v !-✓o G�LS <br />N!�ln�/.t"`i� L.J�'f/f���►nt..i- ��7//��Yw//� r��� ZSi-�!: <br />��dE��'�,�.6s� I �����.� <br />CONTRACTOR <br />PHONE ��/�.� �, <br />VROPOSED USE OF EUILqNO <br />��,�,� p �<.� <br />COHTRACT PRICE OF <br />ADDRE93 <br />PMONE <br />y�s-zs,� - 5 <br />ar conrn. uceNse r <br />BBuilding � Machanical Adaitbn � MEATSouRCE <br />Combinatbn Ptumbi�y WORK B AlUratian I D Electric <br />BDertalitlan Sign TYPE D N�w � fiae <br />Sptlnkler U RptlrMlsint. Other <br />CITY OF EVERETT LOCAL SALES TAX COOE 16 �706 <br />WORI: pESCRIPTON , . <br />�C/ / � c �`c� _ /O �G /a �..rs�%e // ��.t�Ct� <br />P��� ���r�w6.M WQ�� /rYT.e�� �j'i..J�C. � D� <br />! <br />MO. � TYPE OF FlXTURE OR REM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 3 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CIOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOF DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICJBARlMOP/ETC.) <br />OTHER <br />i c r� <br />N0. I TYPE OF FlXTURE OR ITEM <br />A/C -AMANDLINCi UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANOE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPIACE INSERT <br />dAS FIREPLACE <br />�AS RANOE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBV CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATiON AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL <br />PR^VISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHE1'HER SPECIFlED HEREIN OR <br />NOT. THE ORANTING OF A PERMIT DOES NOT PRESUME TO 61VE AUTHORITY TO VIOLATE OR CANCEL THE PHOVISION OF ANY OTFiER <br />STATE OR LOCAL LAW RECaULATIN6 CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. TMA71 AM AUTHOR�ZED BY 7HE <br />OWNER OF THIS P PERTY ERFORM TME WORK FOR NMICM APPUCATON IS MADE AND I COMPLY NATH THE STATE <br />CONTRACTO 8. C 298.200 WAC. <br />; � �-�— /8– Z /–G/ <br />ignature o ed on ra or uthorized pant ts O <br />