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OCT-2d-ZOOB�FRI) 0T:2d <br />PERMIT APPLICATION <br />CITY OF EVERETi' PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - tvww.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />���d�0- 7j1�1 <br />L sE <br />DIOCK <br />DGSC. <br />s���r, I,t) I LSO Yl <br />TENANTNAME <br />PARCEI TAX I,D. A <br />TRACT OR SU�DIVISION C <br />s i vv C-R LAK� �v� <br />CONTACT FOR PERMfT <br />bti G l-�o-�rnz�' <br />...................6�L�D N�C-rt'nNb� .,�„„��� � <br />12�05 NE ►2(c <br />CONTR. LICENSE #��•� /��.1 D I Q� <br />IJ r�G <br />US[ OF BUILDING <br />�C51 DEui� A'(. <br />WORK DESCRIPTION ���C <br />N0. I TYpE OF I'I%TUR[ OR ITEM <br />� Bathlub <br />Lavatory (wash ba�in) <br />_ Showur <br />Kilchan sink & dicpasal <br />_ Dishwashar <br />_ Clothes washer <br />Waler healer <br />� Sink (5crvice/bar/mop/elc.) <br />� Backllo�v preventer <br />Urinal <br />_ Drinking FouNain <br />Floar drain <br />Greaso irap <br />Roaf drains <br />_ Olhor <br />HEAT SOUF <br />_[lectric �Gas <br />� <br />P.001/UO3 <br />PERMfT A <br />AHONE Q,S' DI �'L��'�I0� <br />E-MAILL . Wf✓Ga L�QtiA.CC <br />Ki�2kur,Y( ula 9z5-8�4o�tb <br />CONTRA�T PRICE- OF WORK <br />�ODO•Z� <br />re. �� NL-,3-r R,.�,p Sys�4em -�� n <br />N0. �I TYpB OF FIXTURE OR RC-M <br />�F•- afr handling uniis <br />Forcod air systoms <br />Gas piping <br />WatCr healCr <br />Gas fireplacc <br />Gas range <br />Clolhes dryer <br />Ranpe hoad <br />Exhaustlan <br />Hoat purnp <br />Unit hoator <br />Boiler <br />Relrigerali0n <br />Woodstova <br />Othor <br />CITY OF [VCRCi7 LOCAL SALES TW( CODE IS 9705 <br />I hereby ceritify Ihat I have read and expmined thts application and know the same to 6e true and carrect. All provisians oi laws and <br />ordinaces �overning this lype of work wili be complled with whether speeilied herein or no1. 7he graNinp of a pormit doas not prosumo <br />to give outhority lo violale or cancel Ihe provlsion ol any other state or local law repulatinp canstruction or Ihe portormance ol <br />conslruction. That I am , thori�ed by the o�mer ol ihis property io pertorm the work for which application is mado and I eomply wilh ihe <br />Slate Co Iractors La 0.27 RCW and 29G.200 WAC. I <br />s�J _ . ^ la•2�os <br />Si L�C 01 OwnCr/COnIrAclOrlAuthOri:ed Agenl Uo�e � <br />