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ERMIT APPLICAT�"JN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425•257-8810 - FAX 425•257-8857 <br />SITE ADQRESS <br />�"' St S L � �U i.�a • <br />LEGAL LOT N0. BLOCK <br />DESC. <br />OWNER <br />�l� � 5-�- ��c�0 � <br />TENANTNAME , <br />�lLiMlriA ��� <br />CONTRACTOR �f����[/ � <br />�� <br />('ai � i <br />PHONE <br />3G� ( s'7 <br />PqOPOSEO USE OF BUILUING <br />CONTHACT PRICE 0� WORK <br />N10RK OESCRIPTION� : <br />E <br />��� Z <br />N0. I TVPE OF !'U(TURE OR ITEM <br />WA7EF CLOSET <br />BATHTUB <br />LAVATORY �WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNOFY TRAY <br />CLOTHES WASHER <br />URINAL <br />DFINKING FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVENTER <br />SINK �SERVICE/BAF/MOP/ETC.) <br />OTHER <br />LPARCEL TAX I.D. N <br />TRACT <br />ADDRE55 7aP <br />,�� <br />CONTACTNAME <br />� <br />ADORES9 TJ � �7� /�3 Z�P <br />q�z �� <br />Building D Mechnnical <br />PEFMIT � CombineNon U Plumbing <br />7vPE Demolillan U Sign <br />Sprinklar <br />PERMIT M <br />QdZI 2-D28' <br />PHONE <br />CONTR. LIC SE M <br />it/�uJ /� �39s"�G- <br />Addition <br />Alleralion <br />fJew <br />HepalNMeinl. <br />MEATSOUHCF. <br />Electric <br />Oae <br />Olhar <br />CITY OF EVERETT LOCAL SAlES TAX COOE IS 3106 <br />�.1��4 � � C�'/�� �> <br />N0. I TYPE OF FIXTUHE OR ITEM <br />� <br />A/C — A/HANDLING UN�TS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYEfi <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUS7'FAN <br />� �cREBY CEFITIFV THAT I HAVE FEAO AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO 6E TRUE A�lD CORRECT. AlL <br />PFOVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TVPE OF WORK WILL BE COMPIIED WITH WHEfHER SPECIFIED HERE�N OR <br />NOT THF GRANTING OF A PEFMIT DOES NOT PRESUME TO GiVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE UR IOCAL LAW REGULATING CONSTRUCTION OR THE PERFOFMANCE OF CONSTRUCTION. THAT I AM AUTHOR12ED BV THE <br />OWNER OF THIS PFOPERiY TO FERFORM THE W ORY, FOR WHICH APPLICATION IS MADE AND I COMPIY WITH THE STA1E <br />CONTRACTOR W 1827 RGW AND 29fi200 WAC. <br />���� �� �G -`2- <br />