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P�RMIT APPLICATI�'�N <br />CITY F EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 92201 <br />425-257-8810 - FAX 425-257•8657 <br />S�TE ADORESS � PARCEL 1'AX I.D.1 <br />7 - C' <br />� 50 /`�� -1 S� �jU`•�7�ti� -�x�� ,x.a <br />LEQA LOT Nps BLOCK TR/q/p{ /�J ��/ � �%�,�✓ <br />DE�C. _ j /C[--GYLL� �" iTr/�c_ <br />�nX�l1 �sv .1i1/� <br />TENANT <br />CONTRAC?OR <br />PHONE �f'�C�� — <br />PROPOSEO USE OF BUILDIN6 <br />�� <br />COMRACT PRICE OF WORK <br />WORN DESCRIPTION <br />J`� <br />��s� � <br />� <br />PEFMIT <br />TYPE <br />-z� i <br />NO. � TYPE OF FIXTURE OR REM <br />� WATER CLCSET <br />/ BATHTUB <br />� LAVATORY(WASH BASIN) <br />� SHOWER <br />�KITCHFN SINK 6 DISPOSAL <br />DISHWASH[F <br />"' LAUNDRY TRAY <br />� CLOTHES WASHER <br />�URINAL <br />DRINKING FOUNTAIN <br />FLOOR GRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BARlMO�/ETC.) <br />OTHER <br />!�?/L, Sc� / �' <br />LK sfr..�.✓s <br />NAME / <br />%ii/ C _�l.�.� <br />ADDRESS <br />n 8uilding <br />.F� Combinetion <br />r-5 Demolition <br />D Sprinkler <br />PERMR I <br />�2,rs ts yI� -�jy_ as 73 <br />PHONE <br />��t:s _ yls >�-'y os�� <br />,-- <br />LP COHTR. LICENSE I ' <br />. , • �Lt�i�.d� vy�Pk <br />n Mechenical <br />�} Plumbing <br />D Sign <br />�Addlllon I HEATSOURCE <br />Alteralbn � Electric <br />New Oae <br />HepeirlMeint. Olher <br />CITY OF EVERETT LCCAL SALES TAX COOE IS �705 <br />NO. � TYPE OF FUfTURE OR ITEM <br />_ A/C – A/HANDLIN6 UNITS <br />� FORCED AIR SYSTEMS <br />= HEAT PUMP <br />= UNIT FIEATERS <br />� CLOTHES DRYER <br />�RANGEH000 <br />_ WATER HEATER <br />— METAL FIREPIACE/S70VE <br />= FIREPLACE INSERT <br />L GAS FIREPUICE <br />(3AS RANOE <br />GAS PIPIN(3 <br />EXHAUST FAN <br />_ O7HER <br />I HEREBV CEPITIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PHOVISIONS OF I.AWS ANO OIiIDINACES GOVERNING THIS TYPE OF WORK WIIL BE COMPLIED WITH WHF.THER SPECIFIED HEREIN OR <br />NOT. THE GRANTINO OF A PERMIT DOES NOT PRESUME TO QIVE AUTHORITY TO VIOUTE OR CANCEL TNE PHOVISION OF ANY OTHER <br />S7ATE OR IOCAb UW REGUUTINO CONSTRUCTION OF THE PERFOFMANCE OF CONSTRUCTION. THAT I AM AUTHOHIZED BY THE <br />OWNEF HI PR �ERTY TO RF RM THE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONiR 18.7�1 AN 98.200 WAC. <br />��,%�/����� " � � � J " � <br />ig lu wner/ onlractor/ uthorize penl ate �,%'_ � <br />� I ' / 1.1 <br />L� <br />