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F�:RNiIT APPLICATI(1N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 38201 <br />425-257-8810 — FAX 425-257-8857 — �vww.evereltwa.org <br />AF?LICATIONS ARE ACCEPTED FRUM 6 AM TO 4 PM <br />SITE ADDRESS <br />bs Zo �1 �'v �, � ^�., �-'�``y <br />LEGAL LOTNO. BLOCK <br />VYYIY'�R 1 <br />;��t s � <br />TENANTNAME <br />,—���F�y �o � <br />PARCEL TAX I.D. # � <br />Ov3 l-� oc �� �� � � <br />Tr.ncr <br />O AVORE55 UIITII <br />y� � �1/�� s�, a. b�a, < � .�`'' �,�'� �a <br />J X�� CDNTACT rOR PEFMIT <br />�`U��-�,��.l.�s <br />coNrRacroe Q1/d(/19v�-1,'/T� <br />coNrR. uceNse» �>f l.; illd'�� �� �i'/,1 II` <br />USE OF HUILDING <br />WORK DESCRIPTION � /9 J {�fl� <br />�d h�bl- �-cora �:.,>�f <br />PLUMBING <br />TYPE OF FIXiURE OR ITEM <br />Toilet <br />BathWb � <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Waler heater <br />Sink (service/badmop/etc.) <br />Back(low preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drain <br />Olher ���%�Si,l�/ <br />AD�RESS / / CITY2IP <br />�yl'�' f-/I/)LT S��G"'�'S L�iV��t71( <br />L� �.!� . �),s�.� i u% <br />HEATSOURCE <br />� Electric _ Gas _ Olher <br />!a�'. S i'n � C A� 5� n �� z <br />.�z�.'��c Cdw���. <br />I:(UI <br />3 -9-0� <br />tMIT # � ) ,. <br />/% � � ` C . <br />PHONE <br />PHONE <br />"'�.0 . 7/ � - 3 / 3 �� <br />CONTRACT PRICE OF WORK <br />�7, 5�a.�� <br />!.�- <br />TYPE OF FIXTURE OR ,TEM <br />WC — air handling unils <br />Forced air syslems <br />Gas plping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hooJ <br />Exhaust (an <br />Heat pump <br />Unit heater <br />Boiler <br />Re(rigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br />I hereby ceritify tha[ I have read and examined this applic2lion and know lhe same to be true and correct. All provisions of laws and <br />ordinaces governing Ihis typo of work will bo complied wilh whelher specified herein or not. The granling of a permit does not presume <br />to give aulhority to violate or cancel the provision of any ofher state or Iocai law regulaling construcGon or the pedormance of <br />construclion. That I am aulhorized by lhe owner of lhis property to perform lhe work for which applicalion is made and I comply with the <br />State Conlractors w 1f1.27 RCW and 296.200 WAC. <br />/ �� �- 9- o l <br />