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P��MIT APPLI�ATI�'"� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />_ J�- ZUI�� pcvyo3-��� <br />SITE ADDRESS A CE� TAX I.D. N PEfiMI7 M; <br />qCO, -21r�.��,..� � I Z�i��l"IDn;-In�lnO I �. �-l�'. '%, l <br />LOT N0. � BLOCK <br />DESC. <br />� �� 3� - c�� <br />vrvnenLC� c4C�NOME=��;6Ul.Ul�C nooaess na <br />I�IIn�.�l'�v+C�le,��.##-Zc;n LI'� Sv-eUc�r�t, l�L��- `/��— <br />TENANT ME CON7ACTNAME � <br />_ I %���,�.�n �[rr�l?�1rrt�� <br />CONTRACTOR � eya <br />� �J <br />PHONE 4 <br />DL�Ii'IC' .Aooaess ( �/�J .�Y,S�U('fi <br />PROPOSED USE OF BUILDiNG <br />`7 � f1J I� �L� V'�'1�i L �.I PERMIT <br />� i TYPE <br />CCNTRACT PRICE OF WORK <br />Y/VMK UhSGFIPTION <br />5; �,��►� ��t,-��( �� <br />R� ����1E���ce <br />NO. � TYPE OF FIXTURE OR I7EM <br />� <br />0 <br />� <br />WA I tH GLOSt � <br />BATHTUB <br />LAVATOr�Y (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />OISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />��2���UE'��S�t �'ZS F( <br />Buildir.g <br />�Combinalion <br />Demolition <br />Sprinkler <br />Nechanical <br />Piumbing <br />Sign <br />4Z�5 -3jy - 05-73 <br />PHONE � <br />ZIP CONTR. LICENSE M <br />t.Ec��e�aa�oU4 2k <br />Adtlilion I HEATSOURCE <br />Alteretion R Electric <br />New {� Gas <br />Repair/Maint. U Olher <br />CITY OF EVEREIT LOCAL SALES TAX CODE IS 3105 <br />zZZ <br />NO. I TYpE OF FIJ(TURE OR ITEM <br />Fvc; — n/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />FANGEHOOD <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 CEFITIFY 7HAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND OqI�INACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br />NOT. THE GRAMTING OF A PERMIT OOES NOT PFESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOR�ZED 8Y THE <br />OWNER UF THIS PROPERTY TO PEFFORM THE WORK FOR WHICH APPLICAT�pN IS MADE AN� I COMPLY WITH THE STATE <br />�CO TRACTORS LAW,18.27 RCW AND 296.200 WAC. <br />��.!�'�: �( i�r i��tl'S S�TI�z-� ����I b� ��. <br />rgnature o� Owner ConlrectodAuthonzed Agent D te <br />aa s <br />