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PERMI`� �+PPLIC�TIGN <br /> CITY OF EVERcTT PEF2MIT SERVIC�S <br /> 3200 CFDAR SI12E[T, EVEREIT, WA 992�� <br /> 425-257-8810- FAX 425-257-8�57-�^rrnue.verettwa.org <br /> pppLICATIONs ARE nccEPTED FROM 8 AfYt TO 4 PM � �a(�-1�-( <br /> - I �yT� <br /> SITE ADDRESS f'ARCELTnX I.D. A I OZ- O�� <br /> I3ooy na,.a��e�� ��d oaGv3 � 000 �v�ior, <br /> LF.GAL lOTNO. BLOCK TRACT <br /> IUESC. --- CITYIZIP PHONE <br /> OWNER AUIIIt�JS <br /> I ' L n � �{ 3Gu"i�iS ��4 <br /> y � I Yl �I2 � �1 30Gy 1'0.��ciJ��.e�J ��v �✓cvcf�' <br /> ( � CC.-V� L «A � PHONE <br /> TENANT NAME I CONLICT FOR PER1d1T — <br /> IADII;�!ESS � -- — CITYIZIP PHONE <br /> I CONTRACTOR /LjF/�c�� ���F �ol�,,.�,ty� �i2S�fr� �4'zG <br /> /X�o3 i'••�' C� a�czao /��52 <br /> CONTR.LICENSE p <br /> ���` ���' � ��GJ`� �'r�� I CONTRACT PRICE OF WORK <br /> USE OF BUILDING I — tI1:nT SOURCG <br /> I Electrc _Gas :�iOlher !' ��'�� <br /> I WORKDESCRIPTION h'c�ln�o A-��: Ka�d�e r n�c� 0.-.�'o�ovr Ll«� � l �I'''^� r"�"�J <br /> 1 <br /> � <br /> I pLUMBING MECHANICAL <br /> I Np 7YPE OF FI%TURE OR ITEM <br /> Np, TYPE OF FIXTURE OR ITEM <br /> Toilet NC-air handling units <br /> � Bathtub � Forced air systems <br /> _ / Gas piping <br /> Lava�ory(wash basin) / Water healer <br /> _ Shower j Gas fireplace <br /> Kitchen sink&tllsposal — Gas range <br /> DisMvasher Clothes dryer <br /> Clothes washer Range hood <br /> _ Laondry lray / Exhaust lan <br /> Slnk(servicelhar/mopletc•} j ��e��pump <br /> Backflow prevente� Unit heater <br /> ^ Urinal — poiler <br /> Drinking Fountai — {�efrigeration <br /> _ Ftoor drain � — Woodstove <br /> _ Grease trap� — Other_�— <br /> Root dra�s — <br /> Olher ' — <br /> CI1Y OF EV[RE7T LOCAL SALES TA%COUE IS 7705 <br /> I hereuy ceritify lhal I have read and examineA lhis application and know lhe same to 6e W e and corted. All provisions of laws and <br /> o�dinaces goveming this type of work vnll be complied with whelher specified hereln or not.The granting of a permit does not presume <br /> to give aulhority to violate or cancel lhe provision of any otnr.r stale or Iocal law regulating consWl ea6on is�made and 1 omply with lhe <br /> consWction.That I am aulhorized by lhe owner of ihis pmperty lo perform the vro�k for�vhich app� <br /> St3te Conlractors Law 1827 RCW and 246200 WAC. <br /> ��Y�1� — Z" iS i`�- <br /> S�gnaWre of Owned oNractorlAuthonzed Agenl �a��' <br /> ------- �S a�- —i f 9 /07 <br />