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� <br />I <br />SITE ADDRESS <br />LOT NO. <br />I�ERMIT APPLICATIt�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EV[RETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />,:�, Q�C l7� OG <br />BLOCK TRACT OR SUBDIVISION ri <br />� <br />Gc�ic.��,a�►- ,(��c°��Nso.� �l�rr cc�,a,�� ,4;,�. £T�i��� d25���8-���z� <br />TENANT NAME I CONTACT FOR PERMIT PHONE_ �/ <br />�1�� �L'LIr' MAIL � �75��T'�CI <br />nu�u <br />NT ACT R AUURCJa '�" <br />1�/�Y t-N�TZ O��n��c; d-N7- iL�GIU /3,� A-�c cd �y�n/, <br />CONTR. LICENSE t!�^�/�� . nN�' /C/�CJ G��!?� . <br />7 /� y <br />USE OF BUILDING <br />HEATSOURCE <br />_ Electric �Gas _ Olher <br />� y; . � �� U YG�/ <br />CONTRACT PRICE OF WORK <br />�� G� G: ��1.�%G� <br />WORK DESCRII'TION <br />�Nsrft�i ��-eL<J G-�-s Fu�n.�C� T�' /L��� O�� lrft� <br />i-ui=��AcE .�n1 5�m� 4x�/�`pM � <br />NO. I TYP[ OF FIXTURE OR ITEM <br />Toilel <br />f3athlub <br />L2valory (wash basin) <br />Shower <br />Ki�chen sink & disposal <br />Dishwasher <br />Clothes washer <br />Walen c�alcr <br />Sinl< (servicelbarfmoplela) <br />Backflow preventer <br />Ucinal <br />Drinking Fountain <br />Floor drain <br />Greaselrep <br />Roof drains <br />Olher _ <br />3[UI <br />HAN <br />TYPE OF FIXTURE OR ITEM <br />A/C - air handling unils <br />Fe. oed air systems <br />Gas pipi�g <br />\Nalcr heater <br />Gas (ireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhauslfan <br />Neat pump <br />Unil healer <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TN( CODE IS J105 <br />I hereby cerilify ihat I have read and examined this application and hnow Ihe same lo be true and correct. All provis�ons ot laws and <br />ordinaces goveming ihis type of werk will be complied wilh whelher specilied herein or noL The granling of a permil does not presume <br />to pive authority to violate or cancel the provision uf any ol!�er st2te or local law regwating construclion or lhe peAormance of <br />r,onstruction. That I am aulhorized by the owner of this propeAy lo p��rform the work tor which application is made and I comply with lhe <br />Siato ContrarAors Law 18.27 RCWj�yd .fG., 0 WAC. <br />/ <br />, !fi' <br />SignaWre nt �� <br />�� <br />z "C� <br />