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!J',-c�-�_i.-�.lc 1�:1� �f-�-.'9:PiSf1IT 4�Si i5F.315 T0:14�Sc57885� <br />PERMIT APPLICATIOM <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAP. STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />_/ZS' 7� <br />LEGAL LOT NO. <br />O[SC � <br />V / U W <br />I BLOCK <br />PARCEL TAX I.D. p <br />00 39 Zcr..�oc <br />TRACT <br />� <br />F.1 <br />PEH1,tlT N ( <br />l��i .. - �- . <br />p�ij�'€q' � AODRESS ZIP Pnvnt �Z h- <br />Er�i�2 �h��� /zs- 7yy'`f�',I4J �i�rv� 9�za3 3r3 ��G 5 <br />TENANT NAME CONTACT FOR PERMIT pHONE <br />J��f �2--�__ �C-/�r d�- yis 2�7� - 8 W 5� -- <br />CONIRACTOR ADDRE55 <br />wRJ'+� ��r��r1 �u7f��l �]� � <br />PHONE '/ � �/ %I DYY1 ��U�''e /TZ� <br />ZOIt� I-�BL Y7LU c��:f��L'.� 'G�� <br />PROP03ED USE OF BUILOING <br />� f �C� <br />Ouiidinp Mechanical <br />PERMIT � Combination Plumbin� <br />TYPE Dcmoliti0n Sign <br />Spdnklur <br />ZIP CONTR. IICENSE N <br />���sfr��J�7� �s <br />AdOilwn HCAT SOl1HCE <br />WORK Aller:ition � [U_�ric <br />TYPE New '� '��,�c <br />ePaldMalnl .`.'!mr <br />CONTHACT PRIC[ OF WORK ��J] — I CITY OF EVERETT LOCAL SAl �5 TAX COOE IS 1105 <br />�� � � <br />WORK DESCRIPTION <br />C�� l�Ja�� 1�.e�� I�l� � ��-� <br />N0. I TVP[ OF FIXTUftE OR ITEh1 <br />WATER CLOSET (TOIL[T) <br />BATHTUB <br />LAVATORY (WASH f3ASIN) <br />SHOWFR <br />KI iCHEN SINK 8 UISF'USAL <br />OISHWASHER <br />IAUNDRYTRAY <br />GIOlHES WASHEIi <br />URINAI. <br />DRINhING FOUNTAIN <br />f LOOR GRAItJ <br />PACKFLOW PREV6NTER <br />SINK (S[RVICE/DAWMOP/ETC.) <br />MECHANICAL <br />N0. � TVPE Of FI%TURE OR ITEM <br />JC -A�HANOIING UNiTS <br />FORCEO AIR St'STEh"5 <br />HGAT PUA1P <br />UNIT HFATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />� WAT[R IIEATER <br />MGTAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />IiAS RANGE <br />GAS PIPING <br />[XHAUST F.4N <br />OTHEFt <br />I HEREBV CEk�TIFV THAT I HA\�E RE�D �NU ENL�RJEU iH15 APPLICATION AND KNO�Y TME SAh1E TO BE TRUC AND CORR[CT ALL <br />FZOVISIONS OF LAVJS At:D ORIDUJl.CES GOVFRNIfJG THIS TVPE OF WORH WILL �E C0�•1PLIE0 WI7H 1Vh[THER SPECIFIEU HEREIIJ OR <br />NUT. TH[ GHANTING OF il PEk�11T UGES NUT PRESUh1E 70 GIVE AUTMORITY TO VIOlA7E OR CANCEL THE PRGVISION OF AIJY OTHBR <br />STQTE OR LOCAL LPW REGUV+71tJG l'ONSTRUCTION OR THE PERFORRIAIJCE OF CONSTRUCTIpN TMA71 Atd AUTHORIZ[D �V THE <br />OY:IJER OF THIS PROPERT\' TO PcRFOR�1 THE WORK FOR WHICH APPUCATION IS MADE AP�D I CORIPLV 1ti9TH THE STATE <br />(:ONTR CTOHS LA + 27 RC1V AND 296.04 <br />G1�1a, iw�t_ �u � � --- �'�z�e a4 <br />Si ef ieulOwneiiCunhacluUAyci�pnteJl�yenl Date <br />L/ <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />