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SITE ADDRESS <br />1S(O l <br />LEGA LOT N0. <br />TENANTNAME <br />� <br />PERMIT APPLIC/.1TI01� <br />CITY OF EVERETT PERMIT SERVICES <br />320G CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />T'� Si- <br />BLOCK <br />S iu t`('�'� <br />PARCEL TAX I.D. p <br />gv <br />TRACT <br />�Slo <br />CONTACTFORPERMIT <br />PHONE <br />I �avuJl�{ q�.l(491� so�-z�2�/'tw <br />CONTRAC*JOF{ P�L� re __Ul�f ADORESS �4 / d/ _ ZIP CONTR. LICENSE A <br />w��'� d'N ('�6'�� <br />a�vv�f�rh.�c �f FrrEf 4�r�3 <br />�[.o -z8d- �('� �-`` <br />PROPOSED USE OF BUILOING <br />CONTRACT'PHICE OF WORK <br />I� �uilding <br />PERMIT [� Combinati0n <br />7YPE D Demoiition <br />U Sprinkler <br />Sign <br />i <br />j� Addition <br />IS1� alerauon <br />H New <br />Ll qepalr/M31nt. <br />HEATSOURCE <br />�Eledric <br />Gas <br />Other <br />CIN OF EVERE7T LOCAL SALES TAX CODE IS 3105 <br />WORK UESCRIPTION /J ,�,,, �� � „�.,�, c / t _ / tC � f� 6o�`d <br />c.0 � � r,� �! c_ c C��Y] <br />o �h�Tu l (12�. -� l-Ytac�. �fa.ti-� �l{a�Ld�c�e,�' !�?Q� <br />N0. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILEf) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />^ KITCHEN SINK & �ISPOSAL <br />OISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREIVENTEP. <br />SINK (SERVICE/BAR/MOP/ETC,) <br />OTHER <br />� <br />1.���c f /9/�//� f <br />-t-a ha/�-, <br />NO., � TYPE OF FIXTURE OR ITEM <br />A/C-A/HANDLING UNI7S <br />FORCED AIR SYSTEMS �mc�e <br />HEATPUMP <br />UNIT HEATERS <br />CLOTHES ORYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPIACE/STOVE <br />FIREPLACE INSERT <br />GAS F.IREPLACE <br />GASRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />%O PUOWr '^ <br />I HER'e8Y CERITIF/ THAT I HAVE READ AtJO EXA�.11NE0 THIS APPLfCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PR'�VISIOIJS OF LAWS AND ORIOINACES GOVcRNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. TME ORANTING OF A PERMIT OOES NOT PRESUME TO GNE AU7HORIN TO VIOL4TE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERPORMANCE OF CONSTRUCTION. THAT I Alh AUTHGWZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM i HE l"fORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONT/RJ[�CTORS LA/W� 1827 RCW AND 29F20� N'AC. / <br />Y�i. _1 l 4�__ ,�� l(/7��'1 <br />DEBIT & CREDIT CARDS ARE NOT ACGEPTED <br />t•d cseazszszbz:oi :woa� ss:e0 seaa-sz-nora <br />