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P�RMIT APPLICATIGN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />�`1z7 W. M�K� I�c,v 81��. <br />LEGA LOT NO. <br />oesc. Reala�' . <br />�oddCk�.se <br />BLOCK <br />TENANTNAMEC1�19J�Gt1� (lil�e�QSS <br />Gf o'(-',e-I �r� T'e,G. 't��—, —� e l�e-1S— <br />CONTRACTOR j � �� � ��U'+`�4 `-' <br />U�/ <br />PHONE �-v, �Q � Tv M In-� <br />PROPOSE� USE OF BUILDING <br />5 , 000 . o0 <br />CONTRAC7 PRICE OF WORK <br />WORK DESCRIPTI �1\ Rp-��k� 2 <br />Go�.s-�-r�ei- �N.e� <br />Ca�c%�. �-e s l a b <br />PARCEL TAX I.D. A <br />�4' 17 I DOU 04J O i D°� <br />TRACT �� Pla'� B1 �l,�r I � <br />�I��.$ <br />ACT NAME I <br />AUDRESS <br />�,`�70 <br />Building Mechanical <br />PERMIT Combination R Plumbing <br />7YPE Deinolilion � Sfgn <br />Sprinkler <br />9 �o�tid <br />a-1- �e�� <br />N0. I TYPE OF FlXTURE OR REM <br />WATER CLOSET <br />_ BATHTUB <br />_ LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />_ DISHWASHER <br />_ IAUNDRY TRAY <br />_ CLOTHES WASHER <br />_ URINAL <br />DRINKING FOUNTAIN <br />_ FLOOR DRAIN <br />BACKFLOW PREVENTER <br />_ SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />:RMIT N <br />� <br />�n <br />�f� °�SzO3 <br />PHONE <br />2�i �{-LS-`�67—�1 �� <br />ZIP CONTH. UCENSE k <br />Addition HEAT SOURCE <br />Alteration Electrk <br />New Gas <br />Repeir/Mainl. Other <br />CRY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />� �tn.-}eMq,s m A S�touoM� s H w�1� µ1 ecad � a(,e � <br />E.� t9tP'`,Q�t,f— ��e.C-�tii� � C.0.�0 11Z� D/► <br />o-F c-x�s-h�i.� s-{��-f�►�� � <br />t�O. � TYPE OF flXTURE OR ITEM <br />_ /V(:-AlMANDIIAGUNITS <br />_ FORCED AIR SYSTEMS <br />_ HEAT PUMP <br />_ UNIT HEATERS <br />_ CLOTHES DRYER <br />_ RANGE HOOD <br />_ WATER HEATER <br />_ METAL FIREPLACE/STOVE <br />_ FIREPLACE INSERT <br />_ GAS FIREPIACE <br />_ GAS RANGF <br />_ GAS PIPING <br />_ EXHAUSTFAN <br />_ OTHER <br />I HEREBY CERITIFY THAT I HAVe READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LqWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETFIER SPECIFIED HEflEIN OR <br />NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE AUTHOfl1TY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW qEGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF HIS PROPERTY TO PERFOPM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />7 iiC 2 200 WAC. <br />�/ I S/O z-- <br />S� /Autiianzed Agent Date i/ <br />