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r�ERMIT APPLICAI iON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT. WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />�Z� 1�1oi��ArJ K'� <br />LEGAL LOTNO. <br />BLOCK <br />�1r ����- rZ,�� �� <br />TENANTNAME <br />�>Ylib�� �t � {�I�711J� <br />CONTR. LICENSE q 7• Pi D <br />USE OF BUILDING <br />�•,�� ;���' <br />WORK DESCRIPTION <br />PARCEL TAX I.D. # <br />/7039?�? C� <br />TRACT OR SUBDIVISION # <br /># <br />_ � j '�� <br />' Z. $ ti 1 U IZ ���'„� �-�� G.Fc'rz fi Lc/il dSZ vj <br />CONTACTFORPERMIT <br />r -� <br />�'lt%5�',' �c'���� <br />��'�1'�� <br />HEATSOURCE <br />%� Eledric Gas Olher <br />/I III1�r�C�] G/�IIf�L-C - r �,'�. <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathlub <br />Lavafory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clothes washer <br />W2ter heater <br />Sink (service/bar/mop/elc.) <br />Backtluw prevenler <br />Urinal <br />Drinkinc� Founlain <br />Floor drain <br />Grease irap <br />Roof drains <br />� Other�-� <br />PHONE (,{.—zS — 1�z3 — `7 <br />F•MGIL ��<5�Y"I�'%L��� <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas (ireplace <br />Gasrange <br />Clolhes dryer <br />Range huod <br />Exhauslfan <br />Heat pump <br />Unit heater <br />Boiler <br />Retrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify that I have read and examined this applicalion and know Ihe same tu be true and correcl All provisions of laws and <br />ordinaces goveming lhis type of �vork will be complied �vith whether specified herein or not. The granting ol a permit does nol presume <br />to 9ive authority to violale or cancel the provision of any other state or local law regulaling consWctior or the per(ormanc.� of <br />construclion. Thal � am authorized by the owner of this property to per(orm Ihe work for which applicalion is made and I comply wilh the <br />Stale Conlr2cJors Law 1827 RC1y and 296.ZG0 \VAC. <br />i <br />�� ,�• ,;,�� / 7/j(. v� <br />� I <br />Sign u e of Owner � oniraclor/Aulhoriz °d Agent Date 'Z, <br />YI <br />