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SITE ADDRESS <br />3' Oq �'la� <br />LEGA LOT NO. <br />NAME <br />FE.3MIT APPLICATI�.� <br />CITV OF EVERETT PERMI"f SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />BLOCK <br />a,�is F�re S�sl�:, x,k <br />PHONE ��,�G\�vp Qjz� <br />!✓J 0 0 <br />PROPOSED USE F BUILGING <br />l(1q�Glwyse �0�'Fr�� <br />CONTRACT PRICE OF WOHK <br />WORK DESCRIPTION �a�av� W. PiW� <br />4list. (.� �fna�fs �� <br />NO. I TYPE OF FIXTURE OR REM <br />� _ WATER CLOSET <br />� _ BATHTUB <br />I _ LAVATORY (WASH BASIN) <br />� SHOWER <br />� KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />� _ LAUNDRY TRAY <br />I _ CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />_i OTHER <br />PARCEL TAX I.D. # <br />TRACT <br />CONTACTNAME <br />a. `l��ou Sfii�l. <br />ADDRESS �� aG1L IIIO <br />Building D Mechanical <br />PERMIT R Combinalion U P�umbing <br />TvP[ (-) Demolitian D Sign <br />�S Sprinkler <br />PERMIT A <br />k oyoa-orr� <br />PHONE <br />8P- DIZN <br />�ZS2 CONTR. LICENSE M <br />$G1R�1 �F S Ozud 3 <br />Addition <br />Alleralion <br />New <br />RepaldMaiM. <br />HEATSOURCE <br />Electric <br />Gas <br />Olher <br />CITY OF EVERETT LOCAL SALES TA% COOE IS 3105 <br />li,yp.tl.yt �"t:u na41- b�K� L��lon <br />NO. 1 TYPE OF FIXTURE OR ITEM <br />A/C -A/HANDLING UNITS <br />F017CED AIF, : YSTEMS <br />HEAi PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />I HEREBY CERITIFY THAT i HAVE READ AND ET,�MINED THIS APPLICATION AND KNOW TH� SAME TO BE TRUE AND CORRECT. ALL <br />� PROVISIONS OF LAWS AND ORIDINACES GOVERNING TfiIS IYPC OF WORK WILL BE COAIPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF � PERMIT DOES NOT PRESUME TO GlVE AUTHORITY TO VIOWTE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOC�L lAW REGULATING CONSTRU.^.TION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />04VNER OF THIS PROPERN TO PERFORh1 THE WORK FOR WHICH APPLICATION IS h1ADE AND I COMPLY WITH THE STATE <br />� CONTRACTORS LAW 18.27 RCW AND 29ti.200 WAC. <br />I�`*'L1.4,'�f�,f2�wC.. .V(UL1�rV7f�' .,_�_ -- <br />