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PERM�T �PpL!�AT�^v�� <br />CITY OF E:VERETT PERMIT SERVICES <br />3200 CEDAR STREET, =VERETT, WA 98201 <br />425-257-8810 •- FAX 425-257-8857 — �n�ww.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />� SITE ADDRESS / / PARCEL TAX I.D. # <br />�oi.S 7y�:/7" ,1iY�c'. �C-'G�'/5/-'7ib� -c . � - r C' <br />. <br />�o `'3�-D� � <br />� <br />?ERMIT # <br />�/ ��- <br />,, LEGA LOTNO. i BLOCK 7RACTORSUBDIVISION# I�U �C+ _!�Y-�( I <br />I CESC. 't { \.11�•� <br />I OWNER ) - �7� � � ADDRES$ CITY2IP PHONE I <br />�1 frlc�GiC ,1-�C.aPe�TY .:17c7 L'�.-ity s�.�z- �.b'r�z"� ;'fL�%- <br />� rlCy•o�5i�icry LLc_ SL� i.?Gt� >3?Ci ..?J�-'SfCG <br />' TENANT NAME COIJTACT FC�-' aER1AIT PHO�JE <br />i`l ��i7ti C'F�A-M.V -1- .i Ji r / n,4\. .;/''l'i- �.�.,�L� I <br />i �/y, <br />C Q: �[C'P... l/JFi�.`-i✓v.0 f f1�2T L a' � .� <br />6�dAI V/i:., i�<.'L'<- r,7�' � L'lt'G 17�Y�i: .. <br />. COTTP.a R A�jDDRESS( I V: IP PHOhE <br />'', �.�ti�.�� (�ii14.b.VC�4 ��4II�f:I.�' .'7�L�/ .11y�/�� W • G. , { ��',�/r�%l�/�/CZ' <br />�� � � �CTiC �._`� <br />�� CONTR. LICENS - # C�f���/ <br />C�'�/'SL� J��'�/ <br />I USE UF BUILDING � NEAT SOURCE I CONTRACT PRICE OF WORK i <br />WORK DESCRIPTION <br />) i <br />�r.l1!-y�(-- �rii,iL� <br />Electric Gas Other <br />� 7 (;e r�� [ l �C-et �e � �t ��� <br />NO. � TYPE UF FIxTURE OR ITEA1 <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kiiclien sink 8 disposal <br />Dishwasher <br />Cloihes washer <br />Walen c�alcr <br />Sink (service/bar/mop/elc.) <br />6ackllow preventcr <br />Urinal <br />. Drinking Fountain <br />Floor drain <br />_ Greasc trap <br />_ Roof drains . �. / ,; <br />Other <br />MECHANICAL <br />NO. I TYPE OF FI%TURE OR ITEM <br />WC - air hantlling units <br />Forced oir systems <br />Gas piping <br />Walcr heater <br />Gas hreplace <br />Gas range <br />Clothes drycr <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Relrigeration <br />woodstove <br />O�her �� �'�-- <br />CITV OF F.VERETT LOCAI SALES TA:( CODE IS �705 <br />I I��ereby ceriti(y that I have read and examined Ihis application and know the same to be irue and correcL All provisions of laws and <br />,rdinaces c�oveming ihis type of work will be complied with whether specilied herein or nol The grarling ot a permit does not presume <br />to grve authoriry :o violate or cancel Ihe provision of any other state or toca� la�v ro[�ulating construction or the pertormance of <br />�.rnstructio . That I am authorized by the owner of ihis pmpetly to pedorm !he �vork ior which application is made �nd I co:nply with the <br />State Cor1 actors Law 18.27 RCW and 296. 0 WAC. <br />i _ � , <br />��� �_�,� ��/ <<,f� � .��; e,� <br />S;gnaturd�ot O� �ne,�ConlractorlAutherizdd Agenl Date <br />