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SITE ADDfiESS <br />r% 10 � �,v ST <br />LEGA LOT N0. _ <br />1� ►C NAG _/,(�j.}2� <br />TENANTN�ME <br />�i"l/C IJ� CZ � <br />�.vn�nFGIVH <br />SC-L� <br />PHONE <br />� ti'L S � <br />P�.RMIT APPLICATI(�.� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, Wq g8201 <br />425-257-8810 — FAX 425-257-8857 <br />BLOCK <br />!'�'l �6 � i <br />3`17 _og 3 <br />iPOSED USE OF BUILDING i — <br />�C C K PERMIT <br />TYPE <br />�CG�WRMOTPRICE OF WORK (� C � � <br />"� J <br />PARCEL TA7( I.O. N <br />TRACT <br />CONTACTNAME <br />PERMIT M <br />��O�oo 6 Q�/D -O�( <br />2��GE <br />aP PHONE <br />ST RpZo 3 y2s 3y7-vp3c <br />PliONE <br />ilCl-l4c� /?'l� Gu, <br />A�D1DRESS �,1 <br />I � O � —li�r(.l� $'r <br />�J <br />uilding n Mechanicai <br />Cambinalion � S Plumbing <br />Demolilton p Sign <br />Sprinkler <br />rvuMR pESCRIPTION <br />`DC-GK iN S T�1't-� .4� �� <br />X: c � SQ �C�--� . S.SU <br />NP� `f�-t<3 !N � i�a-[ �� ��� <br />NO. I TVpE OF FIXTURE OR REM <br />I vv,yiCnl.LVOtI <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER�_ <br />— (4ZT) 3 �f �-�b'� <br />LP CONTR, LICENSE M <br />9p2-o3 <br />�ddition HEA750URCE <br />K Alleration I ���t� <br />New Gas <br />— Rapair/Maint Other <br />CITY OF EYERETT LOCAL SALES TAX CODE IS J105 <br />N0. I TYpE OF flXTURE OR REM <br />— rv� - wn�vrvuLING UNITS <br />_ FORCED AIR SYSTEMS <br />_ HEAT PUMP <br />_ UNIT HEATERS <br />_ CLOTHES DRYER <br />_ RANGEHOOD <br />� WATER HEATER <br />_ METAL FIREPLACE/STOVE <br />_ FIREPLACE INSERT <br />._ GAS FIREPLACE <br />_ GAS RANGE <br />_ GAS PIPING <br />_ EXHAUSTFAN <br />_ OTHER <br />I HEREBY CERIiIFY 7HA71 HAVE READ AND EXAMINED 7HIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRE <br />PROVISIONS OF LAWS AND OqIDINACES GOVERNING THIS TYpE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIEO HEREIN OR <br />NOT. 7HE GFANTING OF A PERMIr OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLqTE OR CANCEL THE PROVIS�ON OF ANl' OTHER <br />STA7E OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />CO^TROWNER OF THIS PROPERTY TO PERFORM TNE WORK FOR WHICH APpLICATION IS MADE AND I COMPLY WITH THE STATE <br />A ^ qS LA �1827 RCW AND 296.20p Wq�. <br />D_'i-OL <br />�I2 <br />