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t , <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-88�/10' - F(A]X 422�5-257-8857 <br />�/I% �7 G -{ ��/r�L.i�n <br />SITE ADDRESS { PARCEL TAX I.D. N PERMiT a <br />(�909 ;��l+�l�E w 3`�z; -voa-�oi�-oGoa Co/r/_G! <br />LEGA LOT NO. BLOCK TRACT �� �O Ia� <br />DESC. <br />���� LIY YIIUrvC <br />Gl'�►'rc.c� ,�o� �s .T,rr. 3z�; �,�iy,a�e� ,�i� /0 9� z�i `�z��,o n q� <br />TENANTNAME <br />CONTRACTOR <br />('�f1An'U/C� �ier�lc-s ..r.✓�= <br />PMONE�zr-337 -90�'7 9 <br />PROPOSEO'JSE OF tiUIL01NG <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />/t/'r'�v C.a�%s;.: <br />��yy �� <br />NO. I TYPE OF FIXTURE OR REM <br />.5 WATER CLOSET <br />�BATHTl:B <br />LAVATORY (WASH BASIN) <br />� SHOWER <br />_L KITCHEN SINK 8 DISPOSAL <br />_f_ DISHWASHFR <br />LAUNDRY THAY <br />_L CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BPCKFLOW PRcVENTEH <br />SINK (SERVICE/BAR/MOP/ETC.) <br />ICONTACT NAME <br />ADORE55 <br />3'L2i G�T7�1oiCB�'�0 /g%�/c <br />Building 4lechanical <br />P[RMIT � Combination R flumbing <br />7vae Demolition � Sign <br />Sprinkler <br />�j4s�� 2�/3"L <br />PHONE <br />CONTR. LICENSE N <br />(�/G4/h�%4T o/3kS <br />Addition <br />WORK Alteration <br />IYPE New <br />RepairRdeint. <br />MEATSOURCE <br />�Electric <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />NO. I TYPE OF FIXTURE OR ITEM <br />A!C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEATPUMP -� <br />UNIT HEATERS - <br />CLOTHES URYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIqEPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEFEBV CERITIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF L1W5 AND ORIOINACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIF!ED HEP[IN OR <br />NOT. THE �RANTING OF A PERMIT OOES NOT PRFSUM1IE TU GIVE AUTHORITV TO VIOLITE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGUUITING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY TME <br />OWNER Of THIS PROPEiiN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTFACTORS W 1827 RCW AND 296.200 WAC. � <br />/��s' ��— l9—O / <br />Signa ur� ol OwneuContractor/AWhorized Agent Dale ��� <br />7 � <br />���1� I , 1'/ <br />