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i <br /> R'"RMIT APpLiCATI( V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, Wq g8201 <br /> 425-?_57-88'10- FAX .t25-257-8857-wwv,i,everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SI� � 1DnF+ .r ���—�� <br /> �� � / ,�-��/ � / � PARCEL T,4X I.O.# PERMIT# <br /> / c�.. �/ i ,.7� <br /> • �;�_ li!�•-!- • �_i•��; 'i_ / � /� y/� <br /> LEGAL lnTNq BLOCH TRq Ci(lRSUB�JIVISIONt� t� / r� / �O�O�'/ /oU <br /> D[SC. --/7 ' <br /> OWNER -I / __ �J l'�i! � %i�1 y; <br /> �. , AD�RE�4 V ' CITY2IP <br /> I '"'I � PHONE <br /> c/v�: �� =; .✓,.-f�� %J—(� �'U %'% I' /���� FI � � ._, <br /> ''-;/�z',r� i,l/,:�. �, <br /> TENANTNF� I r��.;, � I'l��•;�j�/N'i <br /> CONiACT FOR PERMIT <br /> PNONE ) <br /> �'� ��Jn 1�{'�i�F:C(S^_� <br /> C N RACTOR ��i �7��� �/ <br /> 1r * c- liDDRE35 � � E•MAIL�.% � /•� <br /> �%: /� /V�ji/ �'�f��"..J ���'2/ CITY/ZP ���i'� I <br /> / P NE '�1LL-V'!i'i <br /> CONTIi.LICENSE il ���;:r- •, -. I <br /> �i.i �,/' . r.— !. : ' ,�'���rJ <br /> / J�iii�/%7J.,�f.,to,,�,�'�;G� t�',/ 7,., � '� v <br /> USE OF BUILDING � /L���� <br /> HEAT SOURCE CONTRACT PRICE OF WORK <br /> i; \_ <br /> •� �-f 1:_"'^_?�2 !/� _�leclric lc Gas Other ��,` <br /> WORK DESCRIPTION � <br /> ;�_ . : �/! I <br /> ��Cc, 3// (/:la�z,� � <br /> � l '-.r:'��;�7Ji�i 7-i��i .rJ/''•-'-r.:�� /� i..-`-� i�' i '! /'/�/' / � I <br /> PLUMBING I'1! I ii.�/. "l �lJ.����G'%�r��'�;��(��il <br /> NO. TYPE OF FIXTUR[OR ITEM MECHANICAL I <br /> I <br /> NO. TYpE OF FIXTURE OR ITEM I <br /> J_ Toilel <br /> 2 t3a�hluh � NC-airhandlinc�unils <br /> L�� Lavalory(�vash basin) Forced air systems <br /> �_ Shower `-I Gas pipin� � <br /> __[_ I<ilchen sink& disposal � W�ter heater � <br /> 7 Dishwasher _L Gas(ireplace <br /> 1 Clothes washer / Gas ranc�e I <br /> _{ Waterheater Z Clotliesdryer i <br /> �� Sink(serviceNar/mop/elc.) � Ranc�e hood ; <br /> _Q_ Oar.kllow preventer � Exhaust fan i <br /> _Q_ Urinal � Heal pwn� � <br /> _� Drinkin9 founlain _/ Unit heater ' <br /> U Roor drain _fZ Ooiler <br /> � Grease Irap � Relric�eration <br /> __[z_ Roof drains � Woodslove <br /> _ Olhcr _ Olher <br /> -- ----� <br /> _ '--------_ — <br /> —_ CITY OF EVERETT LOCAL SALES iAX CODE IS 3105 <br /> I hereby cerilify Ihal I have read and examined Ihis application and know Ihe same to be true and correct. AII provisions of laws and I <br /> ordinaces governing Ihis lype o(work will be complied with whelher specified herein or nol.The granliac�o(a permit does nol presume I <br /> consl ur.iiort��j y��v;o'a.,e'',�zed by��he o v�ner of Ilas pro�perlytlo pertortnitlae wo k11tar�n li ch apppsation is nade a dal comply wi�h Ihr. <br /> Slalc ConIJH<ilorti.Lp}v�9p27 RCVY:.md 296.7.00 WqC. I <br /> :,;.' %;:,�� I <br /> �// '/l I <br /> iignalur� O�-�i�i����Cnnlractor/AidhonzedAgent `S/G/v� I <br /> Datc <br /> ------ ------- --------------- I' I <br /> -- ZJ <br />