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SI7E ADDP,ESS / <br />�1'�35� � cb' <br />LEGA '. �i NO. <br />DE50. � <br />P�RMIT APPLICATIUN <br />GITY OF EVER�TT PERMIT SERVICES <br />3^00 CEDAR STREET, EVERETT, WA 982U1 <br />425-257-8810 — FAX 425,257-8857 <br />J.�' <br />BLOCK <br />/%iCFfil'£L �,Qft%�T <br />1 tfVANT NA'7E <br />PAFiCE! TAX I.D. N� Ao2 noN or_ <br />�$oS"/$oo300200 <br />TRACT <br />.S�K ��oz -ozi- aa <br />ADDRESS nP <br />�V �� �O?— �uv�i+-L /�c.f/ <br />ICONTACTNAME <br />�un;nac��n / ADDRESS <br />/�' Lc�G-"�i:.J6i��-0•��'5.7?�/GncY+��.a/f� �J� �2 <br />PHONE <br />7vU� FS/%-%4�i� <br />PflOPOSED USE OF BUILDINC, <br />Si n/6c� %�ii"�r�-y <br />�cS.�Je�•�� / <br />CONTRACT PRICE OF WOk!C <br />Building �¢�j Mechanical <br />PERMIT Combinalion j� Plumhing <br />TYPE Demolition D Sign <br />SprinKler <br />� <br />i • <br />WORK DESCRIP.ION / , <br />/��L,�ai LaJGt3� <br />r.r•a <br />I — <br />i _ <br />_� <br />�� 8/9•7�1i 3 <br />PHONE <br />LP CONTR, LICENSE M <br />oiJ 3c.�i�,r�c�f/o9?G' <br />Addition HEATSOURCE <br />WORK � Alteralion Electric <br />TYPE New Gas <br />Repair/Maint. Olher <br />CITY OF EVERE7T LOCAL SALES TAX COOE IS 3105 <br />CAti�S�72cic�o�/� S��/Esc.6 /=/1-r-riL�� c/Si.v6i. <br />i3As�c. ���.✓ 4E �03� <br />TYPE OF FIXTUHE OR ITEM <br />WA I tH Gl.OSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAI. <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />UFINAL <br />DRINKING FOI.'\";';H <br />FLO:;, DRAIN <br />BACKFLOW PfiEVE'lTER <br />S�NK (SERVICE/BAWMOPlETC.) <br />OTHER <br />Q <br />N0. I TYPE OF FIXTURE OR ITEM <br />%vi+—/vF'IANULING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HE4TER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSER7 <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER_ <br />I HEFlEBY CERITIFY'HAT 1 HAVE READ AN� EXAMINED THIS APPLICATION AN� KNOW THE �qME TO BE TRUE ANp CORRECT. ALL <br />PROVISIONS OF LAWS AtJD ORIDINACES GOVEFNING THIS TYPE OF WORK WILL BE COMPLIED WITH WH�HEF SPECIPIED HEREIN OR <br />NOT. THE GRANTINu OF 4 PER�v1IT DOES NOT PRESUME TO GIVE AUTH'JRITY TO VIOLATE JR CANCEI THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LA.V qEGULATING CONETRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOR�ZED BY THE <br />OWNER GF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WIT:I THE STA�fE <br />CONTRACT� LqW 18.27 R AND 29F..200 WAC. <br />�k. ����� � �!-.z S"-o: <br />