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SITE <br />_f <br />LOTNO. <br />OESC r <br />� <br />i OWNER n <br />JJ Iri��� �l <br />� TENANTNAME <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-6810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />I/� PARCEL TAX I.D. N <br />h <br />BLOCK TRACT <br />ADDRE55 � CITY/ IP <br />5 ���i �! � 7�1� I..1F� ��� �.n 1��� rr� �� ?l'J�.� <br />I CONTACT FOR PERMIT <br />7 , 1��� <br />PERMIT # <br />�-i�G;(? 7- ��; l <br />PHONE <br />�I CONTRACTOR�,J`.��'' I� I��,''[ �,7(,�Cp.�t���� ADDRES�I t/ //'/�,� �� C„�. CITVlZIP PHONE <br />!.� J [ J I U �7 C�"! �a i K// ('yG� <br />� CONTR. LICENSEt pA uLO R�'��d � p Jul � ��� ���� ���" �" I� <br />USE <br />'� WORK DESCRIPTION <br />l.1 en c+c irQl -��'�e, <br />�� /J��li/t;'I "ll�%��L <br />�� � � <br />d�'-�o'�5 <br />� �{�P7-5 i��. <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />�lectric _Gas_Other ' SQi D�O <br />�.�y-fl��fS a�f��ecfPCi <br />�!✓i� l��i"r�i��� <br />NO. I TVPE OF FI%TURE OR ITEM <br />� ✓ Toilet <br />� _ BathWb <br />. 1 Lavatvy �wash basin) <br />4 Show=r <br />' � Krtchen sr�k & disposal <br />. � Dishwo_',�er <br />�. . Clothes washer <br />� Laundry tray <br />'� Sink (servicelbarlmop/etc � <br />. Backflow prevenler <br />Urinal <br />� _ Drmking Fountain <br />Floor drain <br />Grease trap <br />Root drains <br />O�her <br />d���1o�,�is n:��( l �ii��roo,fL , <br />NO. I TYPE OF FI%TURE OR ITEM <br />A/C — air handhng unds <br />Forced air systems <br />Gas piping <br />Waier hezier <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />� Range hood <br />� Exhaust fan <br />Heat pump <br />Und hcaler <br />Boiler <br />Refngeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TA%CODE IS J705 <br />I hereby centity that I have reaJ and eaamined this apphcation and know ihe same to be true and correct. All provisions of laws and <br />ordinaces govermng this type of work vnll be complied with whelher specified herem or not. The grantmg ol a permit does not presume <br />to grve authonty to wolate or cancel the provision of any other state or local law regulating construction or lhe peRormance of <br />construction That I am authonzed by the owner of th�s property to perform ihe work for which application is made and I comply with the <br />Slate Contractor5 Lay,� 18 27 RCi(J and 296 200 WAC <br />) (',``�� %�1'�. �.a.��i 1�9.JU0.6 <br />Nlcli�JNI --�,I�-rct�'-_ .'_-- <br />