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PEI�MIT APPL:�ATI <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEUAR STREET, EVERETT, WA 98201 <br />425•257-8810 — FAX 425-257-8857 <br />SITE ADORESS <br />�S'� �� SG,) � LOT <br />LEGA LOT N0. BLOCK <br />DESC. -, � <br />aWNER <br />�,i�Lt`.??�A,� �j�j'T )'Vc . <br />TENA��T NAME <br />P'fRCEL TAX I.D, t <br />��l`zJ� 36df <br />CONTACTNAME <br />�I <br />PERMR N <br />'?3=3.Sb'77 <br />PHONE <br />� �t2(S G�EC1E,�i�l , �u = 3s�-7?/6 <br />CONTIIACTOR ADORE88 <br />21P C9NTR. UCENSE I <br />CCitc�RsoJ �o,�sr �nlc, �o,Bcx 3oor ��Tr � C�uFc,�o94r, E' <br />ounue <br />PROPOEED USE OF BUILDINO <br />S/N4(F �+►1Ic�/ �S, <br />/ <br />CONTRAf:T ppICE OF WORK <br />WORK DE'3CRIPTION <br />N�J µo�.SF <br />� Buildlnp <br />PERMR Combinetlon <br />TYPE Demolllion <br />Sprinkler <br />i .�� � <br />Mechenlcal <br />Plumbing <br />Sign <br />Addltio�. I MEAT SOURCE <br />A��'+�� Eleclrk <br />�'�w Oee <br />hepaldMalnt. Other <br />CT' OF EVERETT LOCAL 8ALE8 TA%CODE 18 3106 <br />�I6'o � �a o .�j �Rai9�,c � — ��� G 2/ j'9 <br />Lvr � a= SS. � l.�-�-�, <br />N0. � TVPE OF flXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASiN) <br />a SHOWER <br />KITCI �EN SINK 8 DISPJSAL <br />DISHWASHER <br />IAUNDRY TRAY <br />� CLOTHES WASHER <br />_ URINAL <br />_ DRINKINO FOUN7AIN <br />_ FLOOR DRAIN <br />_ BACNFLOW PREVENTEfl <br />_ SINK (SERVICE/BARlMOP/ETC.) <br />OTHER <br />_L SP�,✓ s T <br />N0. � TYPE OF FlXTURE OR ITEM <br />MC - A/HANDLINt3 UNITS <br />FORCED AIR SYSTEMS, <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYEfi <br />RANOE HOOD <br />WATER F SATER <br />ME7AL Fli EPLACE/STO'/E <br />FIREPLACE INSERT <br />OAS FIREPIACE <br />OAS RANOE <br />OAS PIPIN3 <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERI71h r lHAT I HAVE FEAD AND EXAMINED THIf, ni��LlCi\T10N AND KNOW THE SAME TO BE TRUE AND CORFiECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES QOVERNINQ TH19 TYPE O� WORK WILL BE COMPLIED WITN NMETHER SPECIFIED H�qEIN OR <br />NOT. 1'HE pRANTINd OF A PEHMIT DOES NOT PRESUME TO OIVE AUTHOHIIY TO VIOUITE OR CANCEL THE PROVI510N OF ANY OTHER <br />STA7E OR LOCAL LAW REOULA '1N0 CONSTRUCTION OR THE PERFORMANCE QF CONSTPUCTIOI:. TNAT I AM AUTHORI�'D BY TNE <br />OWNER OF THIS PROPERTY TO PERFOAM THE WORK FOR WHICH APPLICATION IE MADE AND I COMPLY WITH THE STATE <br />CONT�CTORS�AW 18.37 RCW ANO 288.200 WAC. <br />la <br />/ <br />