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PERMIT APPLICATION <br />CITY OF EVERETT PER6'lIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />I� 1 l-��ritl nu.-i- 5� , <br />LEOA F BIOCK <br />DESC. s�� u+C <br />,,, �/- !i s .3/ 5' <br />�.ar�a-� K '�Is <br />TENANTNAME <br />M,2. Mo�n� <br />2e,u.ode(,>:9 *' Re�ai.�� , .�Nc <br />PMONr/��a, (o(o�S-�Doo <br />PROPOSED USE OF BUILDING <br />C An^..C�y�iy1 rt ke."� <br />PARCEL TAX I.D. R <br />Gn55�33 a <br />TRACT <br />/Q,•ver�a /e i4�d <br />ERMIT X <br />Of(I- <br />709� y��Pl w n+��•�98L75 <br />CONTACTNAME PHONE <br />7�5 - �o �3 <br />ADDRESS (D/09 /�thwy,Q�Df.�P CONTR.LICENSEM <br />S�vr�o�i�� u�a . q829� �(�o�ae2o��PP <br />Building Mechanical <br />PGRMIT Combination R Plumbing <br />TVPE Demoiition p Sign <br />Sprinkler <br />CONTRACTPRICEOFWORK'�/s ppp� O a <br />i <br />WORK DESr,p�pTON <br />,� i�,� <br />,r�/ . <br />�Adaitbn HEATSOURCE <br />Alteralbn R} Electric <br />Naw D Gas <br />Repair/Maint. � pther <br />C!^I OF EVERETT LOCAL SALES TA% COOE IS 3105 <br />Ja,rv�a�aD �e,, y�q2e, �/Je��� w.a2/L �+c /'FsidVe To <br />_� <br />N0. I TYPE OF FI%TURE OR REM <br />_ WATER CIOSET <br />_ BATHTUB <br />_ LAVATORY (WASH BASIN) <br />_ SHOWER <br />_ KITCHEN SINK 8 DISPOSAL <br />_ DISHWASHER <br />_ LAUNDRY TRAY <br />_ CLOTHES WASHER <br />_ URINAL <br />_ ORINKING FOUNTAIN <br />_ FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />NO. I TYPE OF FlXTURE OR ITEM <br />A/C - AIHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBV CERITIFY THAT 1 HAVE READ A�D EXAMINED'fHIS APPLICATION AND KNOW THE SAME TO BE TRUt AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINAf,ES GOVERNING TFiIS TYPE OF WORK WIIL BE COMPLIED WITH WHETHER SPECIFIED HEREI� OR <br />NOT. THE GRANTING OF A PERMIT �OES NOT �RESUME TO GIVE AI.TNORITY 1'O VIGLP.TE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LUCAL LAW REGULATING CONSTRUCTION nFl THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 8Y THE <br />OWNER OF TH�S PROPEf1TY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />C�ONT�RAC-i O/RS �IA_�W.1827 RCW AN/D -296.200 WAC. <br />J�GI�. /G1L'J�1kiY//�4- /'�f�0'�Lpi1.W1�J �%'.1—C)� <br />