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a <br />oziia�zuo� iu:ia t•nx azs zs� nns� e�•eeiirr ���iNbrr s�uv�ces <br />SITE ADDRESS <br />LOT N0. <br />PERMIT A�PPLICATIOIN <br />CITY OF EVEt2ETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETI', WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.evereriwa.org <br />APPLICA710NS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK � 7MCT <br />PARCEL TAX I.D. # <br />ooiiooi <br />_ a, --� <br />RMf7 A <br />�U '03a <br />IE <br />� %(/�7_�J7C/— <br />TENANT NAME I CONTACT FOR PL�AHR Pk�E <br />{ ���lQJ7 yUi?fSdv� �/,�J",��1.3���7r7 <br />COI�TR.4CTOR ADDRE53 CI7Y/Z1P PHONE <br />/��,� �� s�t�c��-r� �-1���" Co�i��'ioh�,'y 3025 7�r�� �au� � N� ti�5_3�13 _c7y7 <br />CONTR.LICEtj8E,M � /�/ � <br />rnr�G��l�/k19�/,PU-1 / i fS(%i/ �°� GLa• 1��d <br />USE OF 9UILDINCa <br />r� s�c����--�� <br />NEATSOURCE <br />_ Electric J Gas _ Other <br />WORK UESCRIPTION <br />C6�a�,gin� �i 1 �nr�ace fD �aS �u�i�aa�' <br />NO. I TfPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (waeh basin) <br />Showor <br />KRchen sink & disposal <br />Dishwasher <br />Cbihes washer <br />Watar heeter <br />Sink (serviculbadmoplelc.) <br />Backflow preventer <br />Urinal <br />Drinkfng Fountain <br />Ftoor drain <br />Groase trap <br />Roof drains <br />Other <br />CONTRACT PRICE OF WORK <br />,�.�ODd . `�- `—' <br />!!O. I 7YPE OF FDCTURE OR REM <br />AIC — alr harxiling uniLs <br />_ Forced alr syslnms <br />— Gys p�p�ng <br />Water heator <br />Gas flreplace <br />Ges range <br />qothes dryer <br />_ Rangehaod <br />E�aust fan <br />Heat pump <br />Und hoater <br />^ BoNer <br />Reirigoration <br />Woodstwa <br />_ Other_ <br />C(TY OF EVERETT LOCAL 9lLLES TA%CODE IS 3705 <br />I hereby ceritify that I have read and examined thie applicaGon and know the sama to be We and corteC. fU� provisiona o� laws am1 <br />ordinaces govemi� lhis type of work will be complied with whether specifled Aerein or not.'1io granUng ot a purtnit cioes not presume <br />to give authority lo violate or cancel tho provisan of any othor stete or bcal law regulatlng wnsiniction or tho performance ol <br />construcGon. That I am authorized by the ownnr of this properry to per(orm the work tor whlch applicafion is mado and I comply with the <br />State ConhaGors Law 18.27 RCW and 298200 WAC. <br />.�.. " � � . _ /��. i/1 � ll/� %lCI <br />