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SITE ADDRE55 <br />` GZ� <br />LEGA LOT NO. <br />DESC. � /J <br />TENANTNAME <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-a810 — FAX 425-257-8857 — wrvw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FR0�9 8 AM TO 4 PM <br />�L� �l �r� T1 �� <br />BLOCK <br />q � o—�C <br />� <br />�lU�N, <br />IPARCEL TAX I.D. # <br />p O J OQ y. Op �+ �JI 4�00 <br />TRACT <br />�Il'( �1 S 1 � � <br />I CONTACT FOR PERMIT <br />I--�'UI <br />I�/rfi-�'S1o� <br />PHON�,Z ��,1 Z � <br />e�:_ � 0 �v �M (� _ <br />CONTRACTOR ADDRESS CITY2IP PHONE <br />e �Vl�r <br />CONTR. LICENSE p <br />USE OF BUfLDING <br />WORK D SCRIPTION / ^n <br />C��t7 (� C Ll � f� �itit� � l S' <br />NO. I TYPC OF FI�TURE OR ITEM <br />Toilel <br />�athlub <br />Lavalory (wash bssin) <br />Shower <br />Kilchen sink & disposal <br />Dislnvasher <br />Clolhes washer <br />W aler healer <br />.'nk (serviceNadmop/elc.) <br />Backllow preventer <br />Urinal <br />Drinkinc� Founlain <br />Floor drain <br />Grease lrap <br />Roo( drains <br />Olher <br />HEATSOURCE <br />_ Electric �Gas _ Olher <br />^, � y,�` <br />� <br />CONTRACT �'RICE OF W'ORK <br />y�, ��,�_ �,�� <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas fireplacc <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust (an <br />Heal pump <br />Unit healer <br />Boiler <br />Re(!igeration <br />Woodstoee <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS 3705 <br />I 5ereby ceritify thal I have read and examined this application and know lhe same to be lro� and correct. Ail provisions of IaHs and <br />ordinaces governing ihis type of work will be complied with whether speci(ied herein or noL Tho granling of a permil does not presume <br />�o give aulhorilx lo violate or cancel the provision of any other stale or local law regulaling consiruction or lhe performance of <br />conslructip�.,�Hal I am aulhorized by the owner of Ihis property to pedorm the wor� for which applicalion is made and I coniply wilh lhe <br />Stale �i r�clors�Law 1827 RCW and 296200 WAC. � <br />��-- i l� l 9/ 0 5 <br />'(z <br />� <br />