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SITE ADOFESS <br />�,ao /O <br />IEGAi LOTNO. <br />DESC. / Q <br />G� <br />aERMIT APPLIC.4-'ON <br />CITY OF EVERETT PEaMIT SERVICES <br />3200 CEDAR STREET, cVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />BLOCK <br />/. �r /`'/ <br />PAFCEL TAX I.D. k <br />S3s`�- oo� <br />� � bZo7- <br />PERbtIT r <br />Ca 3 �� - C>/� <br />�Y=r> >'fl -�S'�7 <br />� <br />TEN4NT NAME - CONTACT NAME �� PHONE <br />I �f� �n��lNL �/1f� �G�' /��Jl <br />CONTRACTOR � A�DR2 $� 1 /3 i��/o�C 1 LJ LP CONTR. LICENSE N <br />l�/. G- Z_wl-7�a., nf%-i1... i`•w 1 <br />�:r.L�� <br />PROPOSED USE OF BUILDINO <br />PERMIT <br />TYPE <br />GVrvIMAUlrnwe�rwunrc / �/ � S/ <br />WORK DESCRIPTION / .1 <br />�qhl IM� � <br />NO. I TVPE OF FIXTURE OR ITEM <br />� y ,�,.,,,�.,�� �� P��3 � <br />�,I�-JN�^C � Olin/✓ <br />�udding MeCheniCel Addllion HEA? SOUFCE <br />Combinetion R Plumbing WORK �Allaralion I � Electnc <br />Domolitlon p Sign TYPI: New Ges <br />Spnnkler — Repei�Rdami. Other <br />CITV OF EVEREIT �OCAL SALES TAX CODE IS 7106 <br />Q 2 5 z 8 s t� T"f ��� (�r w: � Sye S'� <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER � ^ A� / <br />KITCHEN SINK 8 DISPOSAL ���J �(� <br />OISH'NASHER j � � <br />LAUNDFYTRAY <br />CLOTF+eS WASHEFi � 'L <br />URINAL n <br />DRINKING FOUNTAIN ' L <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK iSEFVICE.�BAR/MOP�ETC.) <br />OTNER <br />NO. � TYPE OF FI%TUFE OR ITEM <br />NG - NHANDLING UNITS <br />FORCED AIR SYSTEMS <br />IiEAT PUMP <br />UNIT HEATERS <br />CLOTHES ORYER <br />_ RANGEHOOD <br />_ WATER HEATER <br />METAL FIREPLACE STOVE <br />FIREPIACE INSFRT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />—I — <br />I HEREBV CERI7IFV 'HAT i HAVE RE.�1� ANO E:(Ah11NED THIS APPLiCATION ANO KHOW 7HE SAME TC BE TRUE AND CORRECT ALL <br />PPOVISIONS OF l,i�vS aN0 OFIOiNaCES �OVERNING 'Hi5 T"rPE JF WORK WILL BE COMPUED WITH WHE�'MER SPECIFIED HEREIN OA <br />V07 7HE GRnN71NG CF 4 PER�dl7 DCFS NOT PRESUME TO GIVE 4UTHORITV TO VICWTE OR CAPJCEL THE PROVISION CF ANV OTHEP <br />5'ATE OR LOCaL LAW REGUTATING CONSiRUCT10N OP THE PERFOFlMANCE OF CCNSTRUCTIOM TMA7 I AM AUTHOAIZED BY THE <br />CWNEF7 OF'HIS PPC'�ER?Y TO PERFORM TNE WORK FOR WHICH APPLICATION IS IdADE aND i COMPLY WITM THE STATe <br />�CPI7RAC70P5 LAW t 27 �9G'N AND 296 200'NAC <br />