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SITE ADDRESS <br />/C%1 c`? / <br />LOT N0. <br />� � <br />5� <br />rERMIT APPLICATi�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />• /,{ / <br />vr� <br />BLOCK <br />TRACT <br />PARCEL TAX I.D. # <br />U %OCi <br />�( - a $r-D <br />�P RMIT # <br />��� � �C1 <br />OWNER ADORESS SY Z�P PHONE <br />/a 2�/ 2! .� VF� W `l Z S- <br />��,�•a�� � Lo/12�� r''L��S E L�F�'�++ Wi� `��',2ey 355 7539 <br />TENANT NAME CONTACT NAME PHONE ��� S <br />rr Li $ �c��� _FG-�-�S 87v-/s"Y7 <br />CONTRACTOR � � � G <br />J�'' <br />PHONE <br />iED USE OF BUILDING <br />C�F1 iC./FC=� �L <br />✓uS i��:'OM <br />ADORESS <br />Building Mechanica� <br />PERMIT � Combination R Plumbing <br />TYPE Demol:tion � Sign <br />Sprinkler (a of hedds) <br />CONTI7ACTP�iICEOFWORK � / J _;---- � <br />� � - -� <br />ZIP CONTR. LICEN^oE p <br />Addition HEAT SOUfiCE <br />WORK .4lleretion � Electric <br />TYPE New Gas <br />R�.paidMaint. Other <br />CITY OF EVERETT LOCpL SALES TA% CODE IS 3105 <br />WORK DESCRIPTION Rd/�/ �� U� G� j(�/ �/ S z/ �C U�2'� �'£ � �� � Z�{ r/��. <br />��vOM l'J� �irN� �z s�N�S'li�vC� .4/i.a�c�iFt� Z C' 012 �:�.fi��t�i :rc � AN� <br />�-'�au �.�.5 /L��c M�i r�o U� AJ Dr.� flobd cf ��.� � E�wi�f�:..� Z C�a2 <br />, „� ...,�. <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />9ATHTUB <br />LAVATORY (WASH [3ASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />9ACKFLOW PREVENjER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />IJO. I TYPE OF FIXTURE OR ITEM <br />A/C — A/HANDLINC; UNITS <br />� FORCED AIR SYSI'EMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />� WATER HEA'iER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />1_ GAS FIREPLACE <br />GAS RANGE <br />� Gf,S PIPING <br />_I EXHAUSTFAN <br />OTHER <br />I HERE9Y CERITIFY THAT I HAVE FiEAD AND EXAMINED THIS APPLICATION h�D KNOW THE SAME TO BE TRUE AND GORRECT. .�LL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WURK `NILL BE COMPI.IED WITH WH�HER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERP,11T DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TFiE PFOVISION OF ANY OTHER <br />STATE OP. LOCAL I.AW REGULITING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />06VNEA OF THIS PROPERTY TO PERFORM1I THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW.�t8.27 RCW AND 296.200 WAC. <br />� <br />�"�a <br />�/� <br />