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SITE ADDRESS <br />�0023 —' <br />LEG�AI LOT NO <br />� (� <br />PERMIT APPLICATION <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. M <br />; �8z -oav- ooz -rro <br />BLOCK TRACT <br />�c/W ��E ScG. �,Tla/'Z8�/, 2 �c, tJM <br />vWntn��L�,4 M. 5�2�nG�Z nuunrs� z�P PIIONE <br />2���7 N. SP�ir�2 %Po.BoX 21 Ntr�JsaJ,�Jh9883� <br />TENANTNAME I CONTACTNAME PHONE <br />,e,G� K.Lc.+� �+�t c��) s�v - yz'f� <br />CO RACTOR ADDRESS LP CONTR. LICENSE M <br />/c o/1-�n+ C,�-sr ��v. Grk1? P o. Q,oX 3`fo F.d�tr��s g�ozu Nc,�rtFca�58M- <br />PFiONE `i� c—i � 7L/_ �. / t7 I <br />PROPOSED USE OF BUILOING <br />S�� � <br />CONTRACT PRICE OF WORK <br />WURK OESCRIPTION <br />Building DMechanical <br />PERMIT � Combinalion U Plumbing <br />TYPE Demolillon U Sign <br />Sprinkler <br />,��i� 2��y <br />NO. I TYPE OF FIXTURE OR ITEM <br />-9 WATER CLOSET <br />� BATHTUB <br />� LAVATORY (WASH BASIN) <br />SHOWER <br />�KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TP,/1Y <br />T CLOTHES WASHER <br />_ URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />9ACKFLOJVPREVENTER <br />SINK (SERVICE/BAR/MUP/ETC.) <br />OTHER <br />Addition <br />Alleralion <br />New <br />Repair/Mainl. <br />HEATSOURCE <br />B E��«� <br />Gas <br />CRY OF EVERETT LOCAL 'a/'�.ES TAX COOE IS 3105 <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FOfiCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEr1TER <br />METAL FIRE:PLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREdY CERITIFY TF1AT I HAVF READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND COPRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHCTHER SPECIFIED HEREIN OR <br />NOT. THE GRANT�NG OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR ICCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PEIiFORM THE WORK FOR WHICH APPLICATION IS MADF AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />Signalure ol OwnedContracloUAuthorized Agent Date � <br />ol <br />