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P�..;MIT APPLICATIa_ l <br />CiTY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADORESS PARCEL TAX I.D. M � <br />8�i 3� y��`A�vE GV. q2 �—000-�io--o�oo <br />LEGA LOi NO. BLOCK TRA�T�j� �/r �L iJx � Z Q� OO <br />�ESC. Jt'ra/c.r t�� <br />OWNEfl ADDRESS �- ZIP PI <br />�,;;,�„�dru� �ts .�� 3�29 Gtl�'ma���v� �0 9�zo i <br />TcNANT NAME <br />CONTRACTOR <br />�LR�/dr�ce <br />PHONE <br />�f Z.�' S � <br />,t{�i�r�sT✓�. <br />PROPOSEU USE OF BUILDING <br />S�F R- <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />��y,J i!�i�ST. <br />o�y <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAI. <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />F100R DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOPlETC.) <br />OTHER <br />ICONTACTNAME <br />ADDRE55 O LP <br />3Zz.y �'`°r`'9'�t � ��'r <br />Building D Mechanical <br />PERMIT �Combinaiior. [y Plumbing <br />TYFE Demolilion U Sign <br />Sprinkler <br />Y�1Vf1C <br />yZs - <br />3�l - 90 <br />CONTH. LICENSE M <br />�;vLiiv✓/f 1� O/3�5 <br />Adtlition <br />Alteralion <br />New <br />(iepair/Maint. <br />HEATSOURCE <br />. �Electric <br />Gas <br />Other <br />CITY OF [VERETT LOCAL SA�ts 7nn �uuc �o o��� <br />y�� LL 2/�Z <br />N0. I T�'PE OF FIXTURE OR ITEM <br />A/C - A/HANDLING UNITS <br />/ FORCED AIR SYSTEMS <br />HEATPUMP <br />UNIT HEATERS <br />� CIOTHES DRYER <br />L RANGE HOOD <br />� WATEA HEATER <br />METAL FIREPLACE'STOVE <br />FIREPLACE INSERT <br />� GAS FIREPLACE <br />GAS RANGE <br />� GAS PIPING <br />c� EXHAUST FAN <br />OTHEFl <br />i HE(iEBV CERITIFV THAT I HAVE READ AND EXAM1IINED THIS APPLICATION AND KNOW THE SAhIE TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF L1WS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COh1PLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT OOES NOT PRESUM1IE TO GIVE AUTHORIN TO VIOWTE OF CANCEL T4E PROVfSION OF ANY OTHER <br />STATE OR LOCAL 1�1W REGULATING CONSTRUCTION OR THE PEiiFORMANCE OF CONSTRUCTION. THAT I AM AUTF:ORIZED BY THE <br />ObYNEF OF THIS PROPERN TO PERFORM THE WORK fOR WHICH APPLICATION IS MA�E AND I COMPLY �VITH THE STATE <br />cnti7RACTORS WW t827 RGW AND 296.200 WAC. <br />` D le � Z � <br />L <br />