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S�TE ADDRESS <br />���r ,� �%��/r <br />LEOA LOT NO. <br />DESC. �"� <br />,f <br />�v��1�lI�Y1VI� l <br />.�t7lL�!— <br />PMONE <br />�i15 -� <br />j'ERMIT APPLICAT'7N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425•257-8810 - FAX 425-257-8857 <br />BLOCK <br />C57� � - <br />PROPOSED USE OF BUILDIN6 <br />CONTRACT PRICE OF WORK <br />•��nn uca�iM1Y110N <br />S/ � <br />,a'fs,l �� 1 Z � � <br />M7• I TVPE OF FlXTUqE OF ITEM <br />m <br />� <br />� <br />IWATER CLOSET <br />BATHTUB <br />LAVATOr�Y (WASH BASIN) <br />SHOWEF <br />KITCHEN SINK 8 DISPOSA� <br />:ISHWASHER <br />LAUNDqYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVEN'(EF <br />SINK (SERVICE/BAR/MOP/[Tt;.) <br />OTHER�__ <br />PARCEI TA7( I.D.1 <br />9yl 7- ocr.- OctS -C>�J <br />��, �r.sN.�� ,�� <br />� <br />CO ACTNAME <br />� /,�s�s � <br />ADORESS <br />Bui�ding � Mechanlcal <br />PERMIT � Combinalion Plumbinp <br />TYPE Demalilion Sign <br />Sprinkler <br />� <br />,2 <br />y`'s � �''ya-s�. � <br />PHOhE <br />_ �/I.S -� �'�f o5 7 <br />AP CONTq, IJCEN9E I <br />E��C/�.f/b 4'y� <br />Additlon HEAT80UHCE <br />WORK Alleratbn n E�� <br />TYPE Naw KZ Qe� <br />. RepalNMaii;. LJ Other <br />CITY OF EVERETT �pCq� g,q�E3 TA% CODE IS �105 <br />NO. I TYpE OF FIXTURE OR REM <br />I rv�, — /vryANIJLING UNITS <br />Z fORCED AIR S�STEMS <br />= HEAT PUMP <br />— UNIT HEATERS <br />�CLOTHES DRYER <br />fiANGE HOOD <br />WATER HEATER <br />,�. METAL FIREPLACE/STOVE <br />'— FIREPLACE INSERi <br />GAS FIHEPLACE <br />OAS RANGE <br />GAS PIPING <br />�� � EXHAUST FAN <br />_ OTHER <br />I HEREBY CERITIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION AND NNOW THE SAME TO BE TRUE AND CORRECi. ALL <br />PROVISIONS OF LAWS AN� ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITM WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMI7 OOES NOT PRESUME TO QIVE AUTHOFITI' TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL UW qEGULATINO CONSTRUCTION OR THE PERFORMANCE OF CONS7RUCTION. THqi I AM AUTHORIZED BV TME <br />OWNER OF THIS PROPERTY TO PERFOHM TME WORN FOR WHICH APpLICAT10N IS MADE AND I COMPLY WITN THE STA7E <br />CONT�R�, OR$ W�J� .�7 CYVAND26B.200WAC. <br />� �'" �l. /L i�/�.�• � <br />. C l�-���% � �� � <br />/Z / <br />