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SITE ADDRESS <br />�fU9 <br />LEGAL LOTNO. <br />DESC. <br />r <br />PERMiT APPLlCATION <br />CiTY OF EVERETT PERMIT SEftVIC�S <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />42.5-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />E\PPLICAT!ONS ARE ACCEPTED FRC1M 8 AM TO 4 PM <br />TRACT <br />PARCEL TAX I.D. # <br />v�De.,cr �v`,��n- r'�eJ'_ CN�r�Z <br />TENANTNAME <br />5� .., � <br />CONTRAGTOR � � a M J .'� <br />ICONTACT FOR PERMIT <br />/ � <br />�7 ,-0,6 <br />PERMIT N <br />MOccu7- U� <br />13Z1 GJt.d`; �✓L <br />E✓t �c TT cJ a. `1 P i.. / <br />K PH`t"ti 'l.�n ( 3�i�1� <br />��� �_cr5��✓ 3�0-�33-ti9go <br />i• ADDRESS CITY2IP PHONE <br />�3 ��..5�. 360-�3�1- 3c�oo <br />CJNTR.LICENSEk p� �MO�L ����,� 3�I3�v Ii����' � D�Z <br />USE OF BUILDING �I <br />p� jTfJ,3✓ i�^ �/�Me�i.0 cLn <br />i2�cc�d5 <br />WORK DESCRIPTION � � � <br />�JcT w.,. � 'r� <br />HEATSOURCE <br />_ Elec�w ic _ Gas ±� Olher <br />�[i�.nfl-v� �t <br />W1�. l g 22 (o <br />I CONTRACTPRICEOFWORK <br />7�0�000 n—" <br />CPnTrGL ReSTQeo,h� Z fi�2 FJ...AI,...� l��.iiS e..•. Qw�( <br />��<..J Cc.�4c��rcQ ICoomS � GFF�CCi. <br />NO. I TYPE OF FIXTURE OR ITEM <br />J_ <br />Toilet <br />L'alhtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />tNater heater <br />Sink (servicelbadmop/etc.) <br />Back(low preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. � TYPE OF FIXTURE OR ITEM <br />Z A/C — air handlin� units \ <br />J.� Forced air systems (�/q��s� <br />_ Gas piping <br />Water healer <br />Gaa Tireplace <br />Gas range <br />Clothes dryer <br />Rango hood <br />�7 Exhaust (an <br />Heal pump <br />Unit heater <br />Boile� <br />Refr�geration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby cerilify lha� I have read and examined Ihis appiication and know the same to be true and corM; t. A!I provisions o1 laws and <br />ordinaces governing�� lhis type of work will be complied with whether specified herein or nol The granting of a permit does not presume <br />to give authority lo violate or cancel Ihe provision of any other state or local law regulating consWrlion or tha performance of <br />construction. That I am authorized by the ownar of lhis property to per(orm the work for which applicalion is made and I comply with the <br />State Contractors Law 18.27 RCW and 29�201i'vVAC. / <br />7r' .-�7%<� �" ; � G(n <br />Si�natur9 oi wner/Contracior/Authonzed Agent Da e �Z <br />