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.I�n 1. 2i'13 9 CIAIdi <br />SITE ADDRESS <br />LEGAI LOT N0. <br />DESC. <br />OWNEfl <br />��•�' <br />TENGNT NM1E <br />10.67;?] P. 3 <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />q25•257•8810 — FAX 425•257-H857 — www.everetlwa.org <br />APPLICATIONS ARE ACCEPTEO FROM 8 AM TO 4 PM )... ip'% -� � 3 <br />PAFCEL TAX I.D. # <br />� 1g <br />BLOCK TRACTOR SUBOIVISION M <br />pD�RESS <br />d� �+� - cr � ���� <br />� CONIACIFOHPEHMIT <br />In(: 1�'1`J <br />C—V f,i'�Ctf <br />PERIdI g � <br />M <br />2 <br />�12�25R(�661� <br />CONTH�L.�C�,�� OqSR� . <br />n�i <br />USE OF BUILDING HBAT SOURC[ CONTRACT 1'HICE OF WORK <br />l_ - � �Ild � <br />Eleciric as_ Other <br />WORK DESCRIPTION <br />rP,�DDIc�.cQ �jG.S �JraG�c.Q, <br />N0. � TYPG OF FIXtUp[ OR IiEM <br />Tollet <br />B��Ih1Ub <br />Lavalory (wash Uac.in) <br />ShO�vCr <br />K��chon s�nk S disposai <br />Uishwashcr <br />CIo1hC5 wnshcr <br />W�ICr hCnier <br />Sink (servlcePoadnwp/ulc.) <br />BacklloN prov�ntcr <br />W in;�l <br />Diinkinp f�ounlain <br />Floor draln <br />Grcaselrap <br />Rnol drain: <br />Othor _ <br />NO. I TYPF.OF FIIITUR[ Op ITEM <br />A/C — nir handllnp units <br />Forced alr syslems <br />Gas p�ping <br />WBlen c�ater <br />Ga5 Ilreplece <br />Gas ran�u <br />Glothes diyu� <br />Ranpo hood <br />Exh�ust lan <br />Huat pump <br />Unit heaiar <br />l3oiler <br />flehiperalion <br />WouJctovu <br />ou���.�_ _rnQG�..� <br />� <br />CITY OP [V[RETT LOCAL SAL F.S TAX CODE I5 7105 <br />I h��eby ceritlry ihat I have road and examined thls applicahon and know Iho same io be trur anU correcl. A�i provis!ons o� laws and <br />oMlnnce� poveminp this typo ol work N•III lir. r.omphatl wilh whelhor 3petlfletl hercin or nuL Thu nranting ol n pr.rmll does not p�e::mnc <br />lo prvn aulhoiily lo vlolnlo or Cn��Col Ihu provisiun of My olh0r cialo Ur local law rupulalinp Gon7lmr,�lon �� UtV P������i���inCe nl <br />r.onsvur.Uon. Tnat I am aulhwized by Ihr. owner ol lhis pooperly to perlorm �hr. work lor wluch appGcalion L^ madr. and I compry.vith Ihc <br />Stalc Conlractors Law 10.27 HGw antl 29G.200 \NAC. <br />