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�.'ERMIT' APPLICAZ �N <br />CITY OF EVERETT PERMIT SERVICES <br />� 3200 CEDAR STREET, EVERETT, WA 38201 <br />� 425-257-9810 — FAX 425-257-6857 <br />_ y��Q ,� � � -- <br />SITE ADDRESS Ulc( —D S� /`� li •'- nu�,r PARCEL TAX I.D. # <br />v+� OI� UJy JU(� Gv iu2 <br />i�X �� � ) /-�Ul: l.J . i .4F ,c � �n2i� <br />LEG4 LOT NO. BLOCK THAGT <br />DE:.C. G� SP d$ I�Ifi7 <br />TENANT NAh1E <br />ONTRACTOR <br />QL0.0 � <br />PHONE ' !1� <br />7 <br />�-� c� ,.nc � � �, � <br />��i5 !J✓[7U <br />PROPOSE� USE OF BUILDING <br />�%UU � sFIZ • <br />CONTRAI:T PRICE OF WORK C( O <br />CJ O <br />WORK DESCRIPTION <br />'J:n.`G� G.. rvCc.� <br />��,,�,::�c '_�l ��� <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />� <br />♦.wnca� �1� ur <br />i T ��,( <br />Z�. � l_)Fll)��1:5 t0at � �f�2S� <br />CONTACTNAME <br />�.�.� I�� �( � <br />ADDRESS � ZIP <br />��3 �. >�� �� ���� ,i�� <br />�3N Ik . �a�✓rv � �.,n• `t�l� � <br />Building Mechanical <br />PeRh117 � Combinalion � Plum6iny <br />TYPE Demolition Siyn <br />Sprinkler <br />4 <br />UU U , <br />1 J L/U � <br />l� <br />�"� WA7cR CLOSET <br />=� BATHTUB <br />�I LAVATOFY (WASH BASIN) <br />�_ SHOWER <br />I KITCHE�� SI�K & DISPOSAL <br />= DISHWASHER <br />LAUNDRY TRAY <br />_f CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />_ BACKFLOW PREVENTER <br />_ SINK (ScRVICE/BAR/MOP/ETC.) <br />OTHER <br />l�c�_) �o� --iv <br />�F' (iMIT a <br />o3oS -m5 <br />�Z� Z���� <br />PHONE <br />Z`i 5 U��v <br />CONTR. UCENSE N . <br />C�c.c, � �. •. � � �c.,= <br />n Addition <br />�-'S Alteralion <br />�� New <br />LJ Repair/MaiN <br />HEATSOURCE <br />�Eiectric <br />Gas <br />Other <br />CITY OF EVEREfT LOCAL SALES TAX COOE IS 3105 <br />T:�v71� t�..�.,:1./ �le.,:.��..,�� <br />� / <br />( <br />�T" � � C 1 S IC <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C — A/HANDL�NG UNITS <br />� FOFCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />� CLOTHES DRYER <br />� RANGEHOOD <br />� WATEH HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE IIJSERT <br />� GAS FIHEPLACE <br />�GAS RANGE <br />GAS iPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERITIFY'HAT I HAVE READ ANC EXAGIINED ThIS APPLICATION AN� KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIEO WITH WHETHER SPEGFIED HEREIN OR <br />N07. THE GRAMTING OF A PERPAIT DOES NOT P6ESUME � O GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVI.SION OF ANY OTHER <br />STATE OR LOCAI LAW PEGUTATING CONSTRUCTIOIJ OR THE PERFORMANCE OF COtJSTRUCTION. THAT I AM AUThORIZED 8Y THE <br />OWNER OF THIS �E�TY TO PERFORM THE WORK FOR WHICH APPLICATION IS M11ADE AND I COMPLY WITH THE oT^?F <br />) (, U 3 ^ <br />Dale �� \ <br />i, � ) <br />U <br />