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� <br />P�RMIT APPLICATIC�N <br />CITY OF EVER�TT PERPdIIT SEFiVICES <br />3200 CEPAR STREE7, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE A�ORESS [-�(��� PARCEL TAX I.O. M PERMIT N <br />81� C c�C�P-c-EN WaY qS2ol 2coo12l2�00 ( -�I'� <br />LEGAL LOTNo, BLocK TR%1CT <br />OESF <br />OWNER AO�RESS ZIP PHONE �Z�y � �� _��O <br />B��E G-1iP �Pla2ffJe�S (a`I5 3�� �,�E�2�lo4 N�n) Yo2�, NY � od i � <br />TENANTNAME I CONTACTNAME pNONE <br />FN��'.o�rJ�2s �VEPxrrR�ra.i� tarzc-G r�oFFErr 4z�-4-7z-4�o1 <br />CONTR4GTOp <br />ALE Fi P� 'P�a(E�71or.1 <br />PHONE �2S—�I'�JZ'4�0 � <br />PROPUSED USE OF BUILOINO <br />��`(AI L <br />CONTHACT PF�cE OF WORK <br />W�RK DESCRIPTION <br />� J sTn �� <br />A�DRESS ZIP CONTR. LICENSE N <br />23ZZb M/�.PLE VAl1EY k-�WY SE �3-D <br />MAPLC- VAL�Y, W4 �i8o'�.�8 ��If'Sl4"IPI <br />— Bullding I� Mechanlcal I Addilion I HE4T50LIRCE <br />PERMIT Combinotlan ��� Plumbing WORK qltoroilon Q Elcccrlc <br />TYPE Dohlollllon � �� <br />LJ Slgn ITYpE New U Gas <br />Spflnklel RapoidMainl. l, OUia� <br />�.lEw c-o.�.,n[..CG�A.. F�2E <br />�� v.lok.CL�Lc,.�� suPP�-Y A�-'o <br />NO, I TYPE OF FI%TURE OR REM <br />CITY OP EVERET'f LOCAL SALES TAX COpE IS 3105 <br />9PC.JK..f1L yVS-ic..n Inl�.�.�D�J�, /� <br />��eeNc-4o ���a��4. PE.2 ,1FPA �s tz (���D <br />�, 1��� � <br />^ BATH7UB <br />^ LpVATORY (WASH BASIN) <br />_ SHOW@R .� <br />_ KITCHEN SINK 8 DISPOSAL �� ,�.� <br />_ DISHWASHER � Q <br />____ LAUNDRY TRAY ���i�Q�� <br />___, CLOTHES WASHER � <br />_ �AINKINO FOUNTAIN O� �O �� <br />_ FLOOR DRAIN ,`� �O /� <br />_„ OACKFLUW PRE4ENTER ('\� �� <br />_ SINK (SEfiViCFJBAR/MOP/ETC:j�\�� <br />� OTHEF Q!` � <br />NO, � 1YpE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCEO AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />flANaEHOOD <br />WATER NEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSEFT <br />QAS FIREPLACE <br />GAS RANOE <br />GAS PIPINa <br />EXHAUST FAN <br />OTNER <br />�3� <br />I IIERE6Y CERITIFI' Tli/171 HAVE RGAD ANO EXAMINED THIS APPLICA710N AND KNOW 7HE SAME TO 6E TRUE�N� CORRECT. ALL <br />PROVISIONS OF IAWS ANU UFII�INACES DOVEFNIN� TNIS iYPE OF WORK WILL BE GOMPLIED WITH WHE7NER SPECIFIED HEFEIN OR <br />NU7. THE GRANTING OFA PEAMIT �OES NOT PRESUME TO GIVE AUTHOqIiY TO VIOIATE OR CaNCEL THE PRqVI51oN OF qNY oTHEq <br />STATE OR LOCAL lAW liEGULqTING CONS7RUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I A�1 AUTHORIZEO BY THE <br />OWNEq OF ThIIS PROPERTY TO PERFORM THE WORY. FOR WHICH APPIJCqTION IS MA�E AND 1 COMPLV WITH THE STATE <br />CONTftACTOp511�W 10.27 RCW AND 296.200 WAC. <br />I :'� � ...//�� � . 7 _,�.. <br />Slgnaluro ol OwnAr/fld�l�aclot7�ulhadzed ganl Dals <br />