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SITE ADDRESS <br />,3/S %!i'� , <br />LEGAL LOT NO. <br />DESC. 5/ <br />�OWNER � <br />Ci !r/> <br />TENANTNAME <br />C�ONTRACTOR � <br />7e�elJ� � lTiJ <br />�r�ERMIT APPLICAT iON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 ,. <br />� PARCEL TAX I.D. # <br />,li� /Jo,.v i�s-J� �oy�L - OUl -Oa�/ - <br />BLOCK TRACT <br />S�a�1- ols ��f>> <br />G AODRE55 <br />/v. �,� G� .�.r�lr�o !� �'�d�7s <br />FOR PERMIT <br />�� � <br />ADDRESS <br />��rG/ .�yi;.Gie�Ea�a�. �p1'!J" <br />v�-�4 - .Scu '-� <br />PROPOSED USE OF BUILDING <br />S� <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />PERMIT <br />TYPE <br />�Building <br />Combinalion <br />Demolitian <br />Sprinkler <br />/ `�� �� ����� SC <br />NO. � TYPE OF FIXTURE OR ITEM <br />,� WATER CLOSET (l'OILE7) <br />�BATHTUB <br />LAVATORY (WASH BASIN) <br />�SHOWER <br />K "CH�N SINK 8 DISPOSAL <br />L D'�SHWASHER <br />L LAUNDRY TRAY <br />L CLOTHES WASHER <br />" URIN.4L <br />— DRINKING FOUNTAIN <br />L FLOOR DRAIN <br />_ BACKFLOW PREVENTER <br />_ SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />D Mechanical <br />BPlumbing <br />Sign <br />J <br /># <br />?_ vG - 3Go - J/>I � <br />PHONE <br />21P CONTR. LICENSE # <br />,�,oc� �'97ic00 <br />Addilion <br />WORK Alteration <br />TYPE New <br />Repair/Maint. <br />HEATSOURCE <br />�Elactric <br />Gas <br />Olhef <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />NO. I TYFE OF FIXTURE OR ITEM <br />^ A�'C—A/HANDLINGUNITS <br />L FpRCED AIR SYSTEMS <br />� HEAT PUMP <br />_ UNIT HEATERS <br />Z CLOTHES DRYER <br />! RANGEHOOD <br />� WATER HEATER <br />^ METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />L_ GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />' I HEREBY CER'TIFY THAT 1 HAVE READ AND EXAI.�INED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. A:L <br />PROVISIONS OF WWS AND ORIDINACES GOVERNING THIS TYPE OF WORK N'ILL BE COMPf.IeD WITH WHETHER SPECIFIED HEREIN OR <br />�. NOT. THE GRANTING OF A PERA4IT DOE3 NOT PRESUA.tE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />, STATE OR LOCA� LaW REGULATING CONSTRUCTION OF THE PERFORMANCE OF CONSTRUCTItiN. THAT I AM AUTHORIZED BY THE <br />� �WNER OP THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPUCATION IS MA�E AND I COMPLY WITH THE STATE <br />i JNTRFCTORS LAW 1827 RC6V AND Zo6200 WAC. <br />Siynature of Owner/ContrectorlAuthonzed Agent Date <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />`/a <br />