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I <br />I <br />I <br />� — <br />I SITE ADDFESS � <br />O�G � c <br />LEGA LOT N0. <br />DESC. <br />OWNER <br />� i'�.;t` ti^"�� P� <br />� TENANT NAME <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 />BLOCK <br />/. i r /° <br />CONTRACTOF <br />��✓. G. r��-rc..., �Krt,,.� f'V., <br />?HONE <br />PRUPOSED USE Of BUILDING <br />PARCEL TAX I.D. N <br />s 3 S `i - 0�6 -�!R - <br />Z� /, � �< �/ <br />2 3�z <br />� L.G•�. <br />CONTACTNAME <br />WP J �n� <br />�l'L .l%v '!L 3 <br />/ 7E �' c Z.'�,.✓ <br />e���� � <br />AOORES <br />2��z �3l�/C tu <br />� y ,�.„,,�.�J � <br />ullding Mechanical <br />PERMIT Combinalion R Plumbing <br />TYPE Demolition D Si�n <br />Sprinkler <br />CONTRACT PRICE OF WORK / J 7� S� <br />WOFK UESCRIPTION <br />�„�t•.�. �f /� <br />NO. I TYPE OF FI%TURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATOFY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 GSPOSAL <br />DISHWASHEF <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAI <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK �SERVICEBAR/MOP'ETC.'. <br />OTHER_ <br />2s z 8 s�- <br />� � v <br />,/ , <br />2� <br />� 2 <br />jrir� 3q� <br />ZIP CONTR. LICENSE M <br />�✓6-.iNu� �E o�so.✓ <br />PERMIT k <br />C f��, OI — ��� <br />v7 � <br />PHONE <br />7/3S <br />7y�2'ity�� <br />�AdtlNan <br />Allerallon <br />Naw <br />Repeh/Mam1. <br />MEATSOUACE <br />j7 Electnc <br />B Ges <br />O�her <br />CITV OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />/, r (t� �r /^ ��%� f$- <br />NO. I TVPE OF FIXTURE O(i ITEM <br />A/C — OIHANOLING UNITS <br />FOiiCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES ORYER <br />RANGE HOOD <br />_ WATF.R HEATER <br />61ETAL FIREPLACc/STOVE <br />FIREPLACE INSERT <br />GAS FIREPUICE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER _ <br />i NEAEBv CEFITiF'+'HAT i HAVE REAO aN0 E.<aMINED THIS APPLICaTION AND KNOW THE SA�dE TO BE TRUE aND CORRECT. 4LL <br />PROVISIONS OF LAWS AN� OFIDINACES �OVEaNMG iHIS TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIEO HEREIN OF <br />^lOT THE GRnNTING CF a PEP�dIT pOES "IOT PRESUME TO GIVE AUTHORITV TC �llClrlTE OR CANCEL THE PROVISION OF ANV OTHEF <br />STATE OR LOLAL LAW REGUU171NG CCNSTRUCTION OR THE PENFORMANCE OF CONSTRUCTION THAT I AM AUTHORIZED BV THE <br />CWNEA OF'HIS PR�pE?TY'O PEPFCRM THE'.NOFA FOR WHICH APPLICATIGN IS 1dA�E 4N0 I CCMPLY \YITH THE STATE <br />;CNTRACTOPS W W'� �7 RC'N ANO 29fi.�00 WAC. <br />�/� V����.� <br />Signature ol �wneuGontractocAu� on d Agern a�e `/� <br />