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SITE ADDRESS <br />7Y 3 C7 �� <br />LEGAL LOTNO. <br />TENANT NA'dG <br />=��c le <br />PERMIT APPLICATlON <br />CITY OF EVERETT PER�'NIT SERVICES <br />3200 CEDAR STREET, EVEi�ETT, WA 98201 <br />425-257-8810 - FAX 425-257-II857 - www.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />lNc� <br />ewcK ' <br />PARCEL TAX �.D. # <br />TRACT OR SUB�iVI510N # <br />!7t'�lR 73r�( PL,1.,� <br />ICONTACT FOR PERMIT <br />C� �t11S�O�1�Pd' EJL'J ��� <br />I:UfYI1tAl:lUF( �! vn . r <br />Q�rn� Nt�O.� 5 J�t S�5{c°...� 7�/CC� f��i.�i<�e-� Qcr�c1 <br />CONTR. CICENSE tl <br />USE OF BUILDING <br />Co��c°��c�u � <br />HEATSOURCE <br />PERMIT # <br />77G <br />�..c'�ei � 1.✓� `1$.�1� J' <br />_ Eleclric _ Gas _ Olher <br />Cv�3)77/� �S�3�i <br />CONTRACT PRICE OF WORK <br />� ,5, ��i � � <br />WORK DESCRIPTION I I <br />T.�S�c�II CI�0.4E e�-�n.el�ei lil�tH.��,.ti,� ���e'r.�aily-�;� S!�..t Cctb�.,tG� <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilel <br />82lhlub <br />Lavatory (wash basin) <br />Sho�ver <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water healer <br />Sink (service/bar/mop/etcJ <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas firepiace <br />Gasrange <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit healer <br />Boiler <br />P.efrigeralion <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TA'. �ODE IS 3105 <br />I hereby ceriti(y thal I have read and examined lhis applicalion and know lhe same lo be true and correct. All provisions of laws and <br />ordinaces governing Ihis type of work will be complied with whelher speci(ied herein or not. The granting of a permit does nol presume <br />lo c�ive aulhorily lo violate or cancel lhe provision o( any other state or local law regulating conslruction or lhe periormance of <br />conslruction,That I am aulhorized by lhe owner of this properly lo perform the work for which application is made and I comply ,vilh lhe <br />Slale Con i�clors L w 1.27 RC.V�I'and 29G 00 WAC. <br />� � , <br />� % ��j %( ��-7 <br />� //- �'>/� �t 1 /L��✓�I% `-' " �/C�c,C%���`'� �v / <br />8ujrfalure of w�iedCoNraclodAulhonzed Agent Date <br />'IZ <br />