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SITE ADDRESS <br />�1 R Z� ��. <br />LEGA LOT NO. <br />DESC. � <br />PE�RMIT APPLICATIC''I <br />CITY O`r EVERETT PERMII' S�RVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-a810 - FAX 425-257-8857 <br />BLOCK <br />- b/ <.J <br />PARCEL'fAX I.D. M PERMIT r <br />Zgc�I�c{�3-l030o I �' �o�/-���� <br />TRAC7 <br />/2 02 -�,3U -0 2 <br />I�II� S•Ll`��j�evenS 1Zol� #�C)� <br />�-eqc ��;�P� ���J t� �Qa S+P,,P �, t��A 9 <br />iENAN AME CONTACTNAME <br />I I��ev�n Sfo�{2dale <br />PHONE, /�� <br />�-t <br />µ�,yrrQeS NI.✓ •; rfi Z� SS �Ylb's: bk ��te v <br />.,. _. L.-c+h e S a-e�el'� 5, � Pr <br />PROPOSED USE OF BUILDING <br />5'�� �le� �.r�.� lL� <br />CONTRACT PRICE UF WORK <br />WORK DESCRIPTION <br />S�I�Iq�� �Gtr'Y'll�� � <br />J <br />NO. � TY�PE OF FIXTURE OR ITEM <br />C <br />� <br />WA I tR GlOSET <br />EiATIiTUB <br />LAVATORY (WASH BA�IN) <br />SHOWER <br />KITCYEN SINK 8 DISPOSAL <br />OISHNlASHER <br />LAUP�DRY TRAY <br />CLOTHES WASHEF <br />U�INA� <br />DRINKING r'OUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOPlETC.) <br />OTHER <br />, <br />Building Mechanic <br />PERMIT � Combination R Plumbing <br />TYPE Dertiolilion � Sign <br />Sprinkler <br />-s33y-cts�,� <br />PHONE <br />�Zs33y os �3 <br />'�d• ZIP �'pNTFj.LICENSE�� �; Ts <br />' 9 h''ZS$ �r <br />, ' �i LE(-nA..CN,.1oqy►2� <br />Addilion HEAT SOURCE <br />'OHK Alleration Electric <br />YPE, �New � Gas <br />Repair/MainL U Olher <br />CITY OF EVEREtT LOCAL SALES 7AX COOE IS 3105 <br />C-rarage � Q�c�e, <br />���v�n5 SP�e <br />211 "1$ <br />NO. � TYpE OF FIXTURE OR ITEM <br />_L <br />A/C — A/HAND�ING UNITS <br />FORCED AIF SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLO'fHE5 DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEFEBY CERI7IFY THAT I HAVE READ AND EXAMINED THIS APPLIC4TION AND KNOW THE SAME','O BE TRUE AND CORflEC'L ALL <br />PROVISIONS OF 1�1WS AND ORIDIl�qCES GOVERNING THIS Tl'PE OF WORK WILL BE COMPLIED WITH WHEfHEF SPECIFIED FIEREIN OR <br />NOT. THE GRANTING OF A PtRMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF �1NY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONS?RUCTION. THAT I AM AUTHORIZED 8Y THE <br />OWNER OF THIS PROPEAN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND ! COMPLY WITH THE STATE <br />CONTRACTOF,$ LAW �627 RCW AND 296.200 WAC. � <br />ZDO!-/ i� <br />��a <br />