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06/04/2013 20-.40 <br />SITE ADDRESS <br />ZZ /O /�%� <br />LEGAL L07 NO. <br />DESC. <br />OW NER <br />�I'�'.ra�6h !/N <br />TENANTNAME <br />CONIH�A.Pb1���— <br />L�!4� �h.�Gth <br />CONTR. LICENSE tl <br />_�—� <br />USE OF BUILDING <br />��° S <br />WORK�SCRIPTION <br />p/,J/ L L. <br />% <br />D2623 P 001/002 <br />P E t2 M I'�: �A;R P L I G/�'� I ON <br />CITY OF EVERETI` RERMI'T SERVICES <br />3200 CEQAR STREET, �VERETT,. WA 98201 <br />425-257$810 - FAX 425-257-8857•- www.everettwa.org <br />APPLICATIONS ARE AGCERTED FROM 8 AM T0 4 PM (�— 5-13 <br />� <br />BLOCK <br />Z. <br />�a � 5 � SPrµe� t <br />A�f/sSGyz/C2 <br />�ARCEL TNC IA. tl <br />TRACT OR SL1001VISION M <br />AODRE55 <br />' �V/G o0[r� 6�// <br />CONTAC7 FOR PERMIT <br />PERMIT # <br />1�OCa-U12 <br />PHONE <br />'�o/ 3G0-�'6"/-a <br />pHONE <br />4IRLJJ " v�� �ia.rr' � ���.�r <br />3�0/�'��`��- �cr.�" yLr-z3`9�z ��/ <br />9��/ <br />HEATSOURCE <br />_ Elcr.tric � Gas_Y, Othor <br />�.97 � ��Yqa�C <br />N0. I IYPE OF FIXTtJRE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basln) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Watar haatar <br />Sink (service/bar/mop/�tc.) <br />Backflow provontor <br />urinal <br />Drinking Faunlain <br />Floor tlrain <br />Grease lrap <br />Roof drains <br />o�hor <br />N0. <br />CONTRACT PRICE OF WORK <br />3z z�-r- <br />MtGF1ANIGAL <br />1YPE OF FUfiURG OR ITEM <br />A/C —air handling units <br />Forcod oir systems <br />Gas pipirtp <br />Water heater <br />Gas fireptaca <br />Gas range <br />Clothes dryar <br />Range hood <br />Exhausttan <br />Heat pump <br />Unit heater <br />Boiler <br />Rafriga2Gon <br />Woodstove <br />Other <br />CITY OF EVERETTLOCAL SALES TAX COOE IS 9105 <br />� hc�reby canlify tbnt I heve read and examined this application and know the samo to be Uuo and correcc All provislons of laws and <br />ordinaces goveming this rype of work will bo complied wiN whothor spacifiod herein o� not. The gran6ng ot a permil does not presumo <br />to givn authoriry to violat� or cancol the provision of any othor stato or local law repulaUng constiucfion or tho performanca of <br />construciion. That I am authorized by the owner of this propeRy ro periorm the work for which application is made and I comply with the <br />S�ata� C`oftra,� rs Law t�� R�CW�and 296200 WAC. <br />� ��/���fil`l"- � �'- S i � <br />