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�� <br />SITE ADDRESS <br />%OZ/S <br />PL..�MIT APPLICATIC _ J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />PARCEL TAX I.D. R <br />19��� ��l po7���fl��6Zyoc <br />� •- I % —O <br />PERMIT k <br />LEGA LOT NO. BLOCK TRACT A .,_ /� ^ �p <br />DESC. 'LN BOO�—Oo �RII�'w� ILS��FiS /Jl{I. NC•Z� <br />OWNER ADORESS ZIP PHONE <br />Q-��i ln%/L,So�✓ /02/,4" 1��� �[. (/,/. `��2oy �/z1'-3s3-(o�W� <br />TENAN7 NAME I CDNTACT Nh'v1E � • PHONE <br />�.�'i <br />CONTRACTOR <br />5r,ftin,o�l« l�aF�.�y <br />PHONE ���G�S <br />yzS - vg� -9���a <br />PROPOSED USE OF BUILDING <br />5 FQ- <br />ADDRESS ZIP <br />�O'y2P /t^�e!/.l 59 <br />%/a�t-�, vU� 98or1 <br />PERMIT �) <br />TYPE D <br />D <br />Building Mechanicai <br />Combination Plum6ing <br />Demolition Sign <br />Sprinkler <br />CONTR. LICENSE 8 <br />y'u�v�,o,Ero� sT�J <br />Addition HEAT SOURCE <br />Altemtion �Electric <br />New Gas <br />RepaidMainL Other <br />CONTRACT PRICE OF WORK (! 7 G' S'�" CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />/ <br />WORK DESCRIPTION <br />/N4�RZ�UNG• NEu/ DC�C�.�SJ' %a� U�' <br />NO. I TYPE OF FIXTURE OR ITEM <br />INATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOiNES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />�ACKFLOW PREVENTER <br />SINK (SERVICE/BAWMOP/ETC.) <br />OTHEA <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER H�ATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />I HEREBV CERITIFY'HAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAbVS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUAdE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STAT[ OR L tL AYV FEGULATING CONSTRUC710N OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF H�S�ROPER7Y TO PERFORh1 THE bYOFK FOR WHICH APPUCATION IS h1ADE AND I COMPLY WITH THE S7ATE <br />CONTRA OI�S W 1827 RCW AND 296.2CO WAC. <br />(�'I%"O <br />