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S���p��s <br />LEGA ( LOT NO. <br />DESC. <br />OWNER <br />/�l�C L��� <br />TENANT NAME <br />�// �"'� <br />CONTRACTOR <br />P�RMIT APPLICATIt��V <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />%l o �d f�ll� <br />BLOCK <br />S� Ll <br />PHONE <br />PRCPOSED USE OF BUILOING <br />G��A�. <br />�'�.vt^�I C�S <br />CONTRACT PqICE OF WORK ' <br />PARCEL TAX I.D. M <br />TRACT <br />S6/ti/r ��s ii �i- ,QOClCL�lLl.,� /�2 <br />, I CONTACTNAME <br />ADDRESS <br />8uilding Mechanical <br />PERMIT R Combinalion R Plumbing <br />TYPE R Demolition p Sign <br />WORKDESCRIPTION ��u��( WA�L ^ � /CN[t �✓t <br />��R21�G (�,—r,.�,aQ .JAct r,J� ?X�r [�n�ST. <br />�6c t,� � , /x,s��'ac wi.,Oo,J aO���^�Gs <br />Nf;w ZJii�z' In1 2�ctP7ra.' A/G�n • <br />i NO. I TYPE OF FIXTURE OR ITEM <br />_ WATER CLOSET <br />_ BATHTUB <br />_ LAVATORY (WASH BASIN; <br />_ SH04VER <br />_ KITCHEN SINK 8 DISPOSAL <br />_ DISHWASHER <br />_ LAUNDRYTRAY <br />_ CLOTHES WASHER <br />_ URINAL <br />DRINKING FOUNTAIlJ <br />FLOOR DRAIN <br />BACKFLON.'PREVENTER <br />_ SINK (SER'JICE/BAR/MOP/ETC.) <br />_ OTHER_ <br />PERMIT k <br />Boaio-c�23 <br />PHONE y�� <br />%ad� 7 s� <br />PHONE <br />ZIP CONTR. UCENSE M <br />Addilion HEAT SOURCE <br />WORK Alteralion Electric <br />TYPE New I � Gas <br />RepaidMaint. Other <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />�'/z <br />w�CMJ �GdC�wB <br />N0. � TYPE OP Fl7CTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATEFi <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHEfl <br />I HEFEBV CERITIFY 7HAT I HAVE REAO AND EXA�d�NED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF L1W5 AND ORIDINAC[S GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTIPlG OF A PERMIT �OES NOT PRESUME TO GIVE AUTHORIIY TO VIOL;ITE UR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LO L LAW REGUWTIN CONSTRUCTION OF THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OFJ► IS PROPERN TO P RFOFM THE WOFK FOF WHICH APPLICATION IS WADE AND I COMPLY WITH THE STATE <br />CONTFAof S LA�V 18.27 FCW D 296.200 YlAC. <br />G r�-_ ��-ly -oz <br />Signal re ol OwneUContractor/Authonzed Agent Date <br />'/a <br />