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SITE ADDRESS <br />�I,YIx' <br />LEGAL� LOT NU. <br />DESG. ���� <br />PERMIT APPLICATIOnI <br />CIZY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />iv-�v� v�_n�_ <br />BLOCK <br />/�/�alQy �vcF�v <br />TENANTNAME <br />�L y���zyF S'��1� l, <br />CONTRACTOR �� <br />PARCEL TAX I.D. q <br />00 4i�i poc�.r, 4000 <br />TRACT <br />BC�ODR�C.`rS.IV ILCl/GUCi-p�ll <br />Q/�t' Q � - �L, •� . .. G <br />r _ _ .. ...-.-� <br />,� CONT/1FT FOR PERMIT <br />L.��l�/�'�� �• \ <br />� ADDRESS • CITY211 <br />CONTR. LICENSE p OL i� M I� S / y�f S P F <br />USE OF BUILDING <br />S�_ <br />WORK DESCRIPTION <br />r : �� �J� <br />HEATSOURCE <br />_ Eloclric +� Gas _ Othar <br />���v �� ��.Ku^'�..-_ <br />NO. � NPE OF FI%TURE OR ITEM <br />� Toilet • , � <br />Bathlub � � � <br />Lavalory (wash basin) I • r <br />Y Shower�.,� <br />� Ki�chon sink & disposal <br />�! Dishwesheri <br />Y Clothes wesher ! <br />T Wa�er hr,aler i <br />Sink (scrvica/Gadmop/elc.) <br />Dackllow praven�er <br />Unnal <br />Orinkinc� Fountain <br />f loor drain <br />Grease Irap <br />✓ Roof drains <br />Other <br />l I .-�l -d (o <br />_ / �-- <br />PERMIT # <br />�O(v�D- <br />qa 7� e- <br />� P�iONE <br />-�s�7— 38%� <br />-- -` �- PMONE�� <br />y zg'� � si7 � ..3d io <br />� . , <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />PJC - air hendling units <br />�Forced air systems 9 <br />Gas piping <br />� Water hoaten <br />Gas fireplace i <br />Gasrange� <br />Clolhes dryer � <br />Range hood� <br />� Exhaust fan 7{�y� <br />Heat pump <br />Unit heator <br />Boilar <br />� Refrigeration <br />Woodsrovo <br />Olher <br />CITY OF EVERETT LOCAL SALES TN( CODE IS 7105 <br />I hereby ceritify Ihal I havo read and examined Ihis applicalion and know the same lo bo lrue and correct. All provislons of laws and <br />ordinaces c�overning this type ol work will bo complied wilh whalher specified herein or not. The granling of a permil does not presume <br />to give aulhorily to violato or cancel the �rovislon of any other state or local law rogulating construcl(on or Iho peAormance of <br />construction. Thal I am aulhorized by Ihe owner ol this property to periorm the wo�k fnr which applicalion Is made and 1 comply with the <br />Stalo CoNractors Law 18.27 RCW and 296.200 WAC. <br />Signalure ol OwneriContractodAuthorized Agent Date <br />�� Z <br />