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SITE ADDRESS <br />fo3o 56� <br />LEGAL LOT NO. <br />DESC.� 2 <br />PEFtMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERcTT, WA 98201 <br />425-257• 8810 - FAX 425-: �7-8857 - www.everettwa.org <br />APPLICATIONS ARE AC�EPTED FROM 8 AM TO 4 PM <br />S�Ir«+ •` <br />BLOCK <br />j'ro.nK + L�s•. }icri <br />TENANT NAINE <br />.i . . <br />CONTRACTOR p W (�( � (L <br />CONTR.LICENSE# I/ <br />USE OF BUILDING <br />�vPlex <br />PARCEL TAX I.D. # <br />0o�93�eo9aol�2 <br />T/R�ACT <br />Deyer�y �1��i D�V. �% <br />63o P.�rk hvc /�lvk�Il-e� 98275 <br />j3o.a� <br />�] m �� <br />CONTACT FOR PERMIT <br />Lis.� �orn�ny � <br />�d # Z-Qi-ciTviziP <br />r <br />) I � � ��. <br />HEATSOURCE <br />_ Electric � Gas _ Olher <br />��ZB—o <br />yzs- yz3 -9/09 <br />PHONE <br />,S - 3 3 0- 96•9 b <br />PHONE <br />3�g -qss-U <br />♦ <br />CONTRACT PRICE OF WORK <br />ZSo�oo o�77/i2 <br />WORKDESCRIPTION �an5��G+�o^ o�- n��, d�{��� U,� Y"�a�^'� (•t <br />NO. I TYPE OF FIXTURE OR ITEM <br />� Toilet <br />� BalhWb <br />L Lavalory (wash basin) <br />Shawer <br />� Kilchen sink 8 disposal <br />'Y �ishwasher <br />Y Clolhes washer <br />JL Waler healer <br />Sink (service/bar/mop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />_ Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />�' <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />�Forced air systems <br />Gas piping <br />L Waterheater <br />"✓ Gas tireplace <br />� Gasrange <br />� Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Bailer <br />_ Refrigeration � <br />_ Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify that I have read and examined this application and know lhe same to be lrue and correct. All provisions ot laws and <br />ordinaces goveming lhis type of work will be complied wilh whether speciTied herein or not. The granting of a permil does not presume <br />to give aulhorily to violale or cancel the provision of any other state or local law regulating construction or the performance of <br />conslruclion. Thal I am aulhorized by the owner of this property to perform lhe work for which application is made and I comply with the <br />Slate tractors Law 18.27 RCW and 29G.200 WAC. <br />�Z/�/�6 <br />Signatu of wn r/ n or/ uthorized Agent Date 1/Z <br />