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SITE ADORESS <br />23 2� <br />LEGA LOT N0. <br />oesc. �3 �+�, <br />PLRMIT APPLICATIIN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />/En <br />BLOCK <br />PARCEL TAX I.D. A <br />��5�bi� � �f97 �oi3 -o <br />TRACT <br />aQ�ro c��i�a� ,�iu_ �a. <br />aM1T M <br />oac� s -e3 $' <br />C'A20C. �,1E7J2[/�/� e232) ,f'A�i,1/E72 AUE', £v2T, ...V..` <br />TENANTNAME CONTACTNAME PNONE <br />,� �� I 5��s_ <br />/N�L//qEZ M�1 L6i �f - 8 70 -/�f f d �C'�[C <br />CONTRACTOR�A�Q� �QNS%i((��T/(Ju�J ADDqESS . <br />/G A UE, ZIP CONTR. LICENSE M <br />� <br />PFiONE <br />��6 -GsZ-s6a/ ( <br />PROPOSED USE OF BUILDING <br />c X /S Ti-J �, <br />S/N G[t P,qM �E"E3/o <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />Fav„��� r� <br />PERMIT <br />TYPE <br />i j • <br />C2�4ck <br />Na• � TYPE OF FlXTURE OR ITEM <br />_ WATER CLOSET <br />_ BATHTUB <br />__ LAVATORY (WASH BASIN) <br />_. SHOWER <br />_ KITCHEN SINK & DISPOSAL <br />_ DISHWASHER <br />_ LAUNDRY TRAY <br />_ CLOTHES WASHER <br />_ URINAL <br />_ DRINKING FOUNTAIN <br />_ FLOOR DRAIN <br />._ BACKFLOW PREVENTER <br />_ SINK (SERVICE/BAR/MOP/ETC.) <br />_ OTHER <br />�?/ .?n.b , N c,�. <br />/ysUL. /�Iq, 9�271 /hAL�Yc Q77Qq <br />duutling I") Mechanical I f1 Addiiion HEA7 SOURCE <br />Combination F_� Plumbing WORK K qlteralion � Electric <br />Demolilion LJ Sign TYPE �,.,1 NeW Gas <br />Sprinkler �29 RepaiqMaint. Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Rc`p�9/.L � CQNc. -ST,q/2l�I�LL �QE',Qd/GD <br />MECHANICAL <br />N0. I TYpE OF FlXTURE OR ITEM <br />_ wt%—n/HANDLING UNITS <br />_ FORCED AIR SYSTEMS <br />HEAT PUMP <br />_ UNIT HEATERS <br />_ CLOTHES DRYER <br />_ RANGE HOOD <br />_ WATER HEATER <br />_ METAL FIREPLACE/STOVE <br />_ FIREPIACE INSERT <br />_ GAS FIREPLACE <br />_ GAS RANGE <br />_ GAS PIPING <br />_ EXHAUSTFAN <br />_ OTHER_� <br />I HEREBY CERI7IFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF tAWS 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 OTHEH <br />STATE OA LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PqOPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTOPS lAW 18.27 RCW ApND 296.200 WAC. <br />� �l/�.1 ��I Y Z z - �a� 2 <br />Signalure of Owqeriuonvac�inutnonzetl Agent ate <br />�/� <br />