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D��. 3 201'[ 3�34Pi;1 <br />SITt AODR[SS � <br />oo� ' <br />LEGAL LOT NO. <br />DCSC <br />TENANTNAMC <br />PERMIT APPLI�ATION <br />CITY OF EVERETT PERMIT SERVI�ES <br />3200 CtDAR STREET, EVERC-TT, WA 9�201 <br />A25-257-8810 — FAX a25•257-8857 — www.everettwa.org <br />APPLICATIONS ARE AGCEPTED FROM 8 AM 70 4 PM <br />' D r V�/ f:v �t <br />OLOCK <br />%t t S%J �c- . <br />In�. 1�'�5 B <br />USE 0� OUILDINC <br />VdORK UESCFiIPTION <br />"�t'�-Q' <br />PARCEL TAX I.D. # <br />iRACT OR SUBDIVISION a <br />CONTACT FOR PEHh71T <br />F.-IA <br />�V PX'P,ft q$' <br />ho 6219 P 2 <br />� .ay-rZ <br />PERh71T if <br />�: <br />uz5z5�f��6� <br />HEAT S�CB I CONTRACT PHICE OF WORK <br />_EloClrl�_ a^ Olhr,r I �;,,�'��� <br />� �s -�j rn p� C.i� <br />N0. I TYFE OF FI%iUR[ OR ITEM <br />Tolict <br />_ Oa�Mub <br />_ __ Wvatory pvash basin) <br />f Shovier <br />_ J Kllchen sink & d�spOsd� <br />DishwJShCr <br />Ciothes was`�er <br />Watr.r hoaler <br />_ Sink Iservice�bar/mop�r.lr,.) <br />back�low prevenler <br />U�inai <br />Drinking Pounlein <br />hloor Jrain <br />Greasr.lrnp <br />Rool dr�ln� <br />Olhur <br />MECHANICAL <br />N0. I TYPC OF FIXTURE OH II[td <br />A/C – ah handlinp units /'�� <br />�_ Forcud ar systems �� �'lJ rhGl-�.,@.,.,a <br />Gas p�pinp <br />—, WalBf h�DICf <br />__. G�s llmplaco <br />__. Gas iange <br />_ Ciothes dryer <br />� R�npe hood <br />� E%hausllan <br />� Hr.at pump <br />Untl heator <br />' __ Bader <br />_ Relrigerahon <br />� Woodslove <br />_ Olhor .___ <br />CIIY OF EVEOETf LOCAl9nLLS TN( CODE IS 9105 <br />I heroby cuntily Ihal I have read and oxaminod Ihl3 applicat�on and know Ihe same lo be Irur, and councl. All prov�5inns u1 laws and <br />ord�naces goveming lhls iype ol wu�k will be tomplled wllii whether spricilied h3rain or noL ihe grantinp ol a permll dnea not presume <br />to p�ve aulhodly 10 vlolalo or wncul tl�e provislon ol any o�her slatr. or locol Inw repul�tlnp consiruct�o�� ur Ihr, pedormanco ol <br />cunstruaion. lhat I am aulh�nrcd by �he ownor o( ihi, property to pedorm Ihr. work 1oi which appGcatlon ia rnade and I tomply wnh the <br />Slato Cunlractors L�w 1R.27 RCW antl 2'J61U0 WAC. <br />. <br />��. �c _� 31a <br />Sipnalu .. ol Uwncr/Cu actor/Aulh �pent Uat2 <br />