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SITE ADDRESS <br />�� <br />LEGAL LOTNO. <br />DESC <br />Mi�E <br />TENANTNAME <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICAT�ONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCH <br />n_il� <br />PARCEL TAX I.D. # <br />r� <br />TRACT OR SUBDIVISION M <br />CfTy DF <br />CO�TACT FOR PERMIT <br />�tS�;lc� ��lD�12SC�lv <br />CONTR. LICF.NSE t �O/W �y O�"" w v <br />USE OF BUILDING <br />HEATSOURCE <br />_ Eledric X Gas <br />/O —S..�l% <br />PERMIT p <br />l_� 1��\L' I�` <<_^� <br />1202 -09 -00 <br />PHONE <br />iZ70 '�25-33D-91Q-f- <br />rHONe 3V0-45'f'-5�37 <br />I CONTRACT PR�CC OF WORK <br />ocr,e� 2 (� 5D . °o <br />WORKDESCRIPTION �r�,y�Ovr �,/r/i / si ���+..{�J J/ � �,y�O����r{�Ju <br />Ti/� / G VY��Y�Ll... ivN p�� � <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilet <br />BalhWb <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Smk (service/badmoo/etc ) <br />Backflnw prevenler <br />Unnal <br />Dnnking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />NO. I TYPE OF FIXNRE OR ITEM <br />NC — air hanCling unds <br />Forced air systems <br />Gas pipina <br />Water heater <br />Gas freplace <br />Gas range <br />Clcthes dryer <br />Rangehood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Re(ngeration <br />Wo�dstove <br />Olher _ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />I hereby certity that I have read and examined ih�s applicat�on and know the sarr,e ro be lrue and correct. AC provisions of laws and <br />ordinances goveming ihis type of work � be compBed with whether specified herein or noc The granbng of a pertnit does not presume <br />to g�ve authonty to violate or cancel th , rovision of any other state cr local law regulating construction or the performance of <br />conslruction ?hat I am authonzed b� the owner of th�s property lo perform the work for H�hich application is made and I wmply wilh the <br />&tel ontractors Law 1827 RCW� nd 296 OD WA � <br />�,; �, �;y ��� ���o. li � 9Z%'/D <br />�' � _ _ � t�-F <br />+ <br />;:���_��-��� --�'�CC�'?� tc',�. �I��s <br />