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P�RMIT APPLICATI^N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREE.T, EVERET f, WA 99201 <br />425-257-8910 — FAX 425-257•88G7 <br />_ _ � 3�� ��a <br />SITE ADDRESS PARCEL TAX I.D. R � PERMR 1 <br />1_sc�� 97� /�[ sE oop�l- -��z� - � ! �'0307 -D�� <br />LEGA LOT NOa, BLOCK TRACP') � <br />oesc.� G�j � <br />OWNER <br />�GL•U j/ i�ui1 ��r�� .i.✓C' <br />TENANT AME <br />CONTRACTOR • - • <br />sy�� . <br />PHONE , <br />PROPOSED USE OF BUILDING � <br />��^ <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />B�l � � . <br />ZZz� <br />N0. � TVPE OF FIXTUFE OR REM <br />T` WATEFCLOSET <br />� BAYHTUB <br />L LAVATORY (WASH BASIN) <br />— SHOWER <br />j� KITCHEN SINK 8 DISPOSAL <br />,_(_ OISHWASHEH <br />� LAUNORYTRAY <br />L CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />�Cil(J .St� ��°i/� �HM) � <br />L JC iti-�•i..;r `J��' JS :Y <br />�z-//L <br />c <br />� LP PHONE <br />CO ACTNAME � <br />�'t'r///7 , �%�'�/�?-!''�--_ <br />ADORESS • ' Z�p <br />a <br />'S -��!�-a5 7 <br />PHONE <br />-s- y-.�s� <br />.._,: <br />CONTR. UCENSE � <br />� Building �� Mechanical Addition HEAT SOUACE <br />P6RMtT r.� Combination Plumbing WOHK � Anerallon � Electric <br />IYbE � Demolilion Sign TYPE New Oee <br />Spfinklef qepaldMeint. Olher <br />� <br />CITY OF FVERETT LOCAL SALES TA% CODE IS 7105 <br />N0. � TYPE OF FI7RURE OR ITEM <br />A/C – A/HANDLING UNITS <br />FORCEO AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATEFS <br />CLOTHES ORYER <br />RANGEHO00 <br />WATER HEATER <br />METAI FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPIN(3 <br />EXHAUSTFAN <br />OTHER <br />I HEPEBV CERITIFV THAT I HAVE READ AND E7(AMINED THIS APPLICATION AND KNUW THE SAME TO BE TRUE AND CORRECT. ALI. <br />PROVISIONS OF LAWS AN� ORIDiNACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETHEF SPECIFIED HEREIN OR <br />NOT. THE (iRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHOHITY TO VIOUTE OR CANCEI. TNE PROVISION OF ANV OTHEii <br />STATE 01i LOCAL lAW REGUUITINO CONSTRUCTION OR THE PERfORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNE OF ic vROPERTY TO PEPFORM THE WORK FOii WHICH APPLICATION IS MADE AND I COMALV WITH TNE STATE <br />CON �RSL,A'�:iB_.'.qCly-AND298200WAC. <br />-�- /i / � 7 <br />�_% /'� /,�./<i'�`--" / �� � <br />ipna re o wned onlraclor/ uthonze pent ale �/� <br />