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SITE ADDRESS <br />�t� ,� , <br />LEGA l01 NO. <br />DESC. <br />OWNER <br />^tC W�.� 1 <br />TENANTNAME <br />�'�ERMIT APPLICAT'ON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />t � ��� .�� <br />BLOCK <br />�bl. If %':'l <br />PARCEL TAl( I.D. M <br />S3Sy- oo . -�� <br />TRACT <br />1 /, � �s �4.t� <br />ADD 5 2 j/1 /3d <br />�w� L G•�• L},�..V�a� <br />�CONTACTNAME <br />wP, .�-�,w � <br />I � CONTRACTOF / -7 <br />�:�, lf - .L �✓C'f�swr �n�iLaa 7%w <br />� <br />PHONF , <br />PRGPOSLD USE OF BUILOING <br />,�vJ Pi✓ azo,_ <br />PERMIT M <br />-vw�/ Co3�c—D�� <br />�._'�3 <br />y�r, 3 <br />�'✓ l ytri !i`2'��'�% <br />YQv� � <br />PHONE <br />���s <br />ADOR25$ 2 i3 ��-?P� J u ZIP CONTR. L.CENSE M <br />3 <br />�,/l✓NFc.lf a/SDn/ <br />� y,,,,,,",,,,,/ � P���� <br />�Builtling Mechanical <br />PERMIT Combinolion R Plumbmg <br />TYPE Uemolition [} Sign <br />_ SprinNter <br />CONTRALT PHICE OF WORK / 7�i S� � <br />WORK OESCHIiTION <br />�� i �+>.. , �i <br />NO. I TYPE OF FI%TUHE OR ITEM <br />WAT[F CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />_ KITCHEN SINK 8 OISPOSAL <br />DISHWA�HER <br />LAUNDRYTRAY <br />_ CLOTHES VNASHER <br />URINAL <br />DRI�IKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLUW PFEVENTER <br />=I SIPIK �SERVIC6BAR/MOP,'ETC.) <br />OTHER _ <br />� <br />2 5 7 8 s�f- <br />���� L <br />� <br />Z�� <br />� <br />AtlAition <br />Alteiallon <br />New <br />Fapair/Maml. <br />HEATSOURCE <br />(�} Electnc <br />B Gae <br />Olher <br />CITY Of EVERETT LUCAL 9ALE9 TAX CODE IS 3705 <br />/> �. G,c �.-:7� Sye �$- <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/G -A/HANULING UNITS <br />_ FORCED AIR SYSTEMS <br />NEAT PUMP <br />_ UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />_ WATER HEATER <br />METAL FIREPLACE'STOVE <br />FIAEPLACE INSERT <br />_ GAS FIREPLACE <br />GAS NANGE <br />_ GAS PIPING <br />_ EXHAUSTFAN <br />_ OTHER <br />I HEREBV CERITIFV :IiAT i HAVE REAO ANC EXA�dINED THIS APPLICATICN ANO NMOW THE SAME 70 BE 7RUE AND CORRECT ALL <br />PaOV1510NS OF �.AyyS 4ND CNID�NaCES GUVERNiNG iN15 T'PE OF WORK WILL 9E COMPUED WITH WHETHER SPECIFiED HEPEIN OA <br />NOT THE aPANTING OF 4 oEPM1T DOFS NOT PRESUME TO G:VE AUTHORITV TC VIOLA7E OR CANCEL THE PROVISION OF ANV OTHER <br />STATE OA LCCaL LA W REGUL4TING CONSTRUCiION OR 7HE PEFFOPMANCE OF CONSTRUCTION THAT I aM AUTHORIZED B1- THE <br />^,lA'NER OF "HIS PR ERT'I TO PEFFQRM THE WOPK FOR N�HICH APPLICATION IS �dAOE ANC I COMPL�� '.NITH TME STA7E <br />CONTRACTOFS LAW + 27 RC'N AND 296.200 WAC, <br />Signe��ul�wnevContrac�uvAu on dAgeni � a� le �� <br />