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e <br />SITE ADDRESS <br />-, �� � �� �� <br />LEGAL LOTNg,. <br />oesc. J <br />OWNER <br />��QC11� �� � <br />TENANTNAME <br />1 V1� <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-88�7 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK <br />� <br />PARCEL TAX I.D. # <br />.+.. 2 �...�,. <br />TRACT OR SUBDIVISION tt <br />�(l[���,��1r <br />CONTACT FOR PEflMiT <br />� <br />a-��-o� <br />:RMIT # <br />� �x7/>Z-o <br />�`�� I <br />rizia anoNe q ,1�.� aY�}� <br />����.Y�f �� �;�,1 Q�'� �c <br />PHONE�y ('(1�"� � ' '1--� LI� <br />F.ldAIL 1 \N�1Ii�S�1���_�AFi-1I��..���f�� <br />�-� HVunCJ.a <br />i,��L�iUa�l�il1 %�G1i1�`� c��l��, �l���`�����.�ti L <br />ISE # _ J e /, .a�� , <br />USE OF BUILDING <br />�t�SiC�t' Il-�C� � <br />WORK DESCRIPTION <br />_ Electric � Gas _ 01her <br />��Y �1� t-1;��. <br />���I% '���� <�1�1� <br />CQNTRACT PRICE OP WORK <br />�(�IC�CU�C� LO � il�:���� �,��:t�Y� ��CY��n V���- ( i 9�� ��' iI <br />_ �CJ � „ - ,,. , _ �—, t__.. ., .�, i_�„ <br />ryp, I TYPE OF FI%TURE OR ITEM <br />�_ Toilet <br />�_ Bathtub <br />Z_ Lava�ory (wash basin) <br />(_ Shower <br />_i — Ki�chen sink & disposal ` n �,,�% <br />i Dishwasher J <br />� Clolhes washer � <br />1_ Waler hea�er � T 1 S���l°� <br />Sink (service/barlmoplelc.) <br />Backliow prevenler <br />Urinai <br />� Drinking Founlain <br />� Floor drain <br />Greasetrap <br />� Roof drains <br />__— O�her —__-- -- <br />N0. I TYPE OF FIXTl1RE OR ITEM <br />.4lC - air handling uni�s <br />_ 1 Forced air systems Gx � STI N l� <br />._ Gas piping <br />_�_ Walerhealer ck �Si � N � <br />_ _ Gas fireplace <br />___ Gas rangc <br />Clothes dryer <br />_ 1 Rangehood N�w' <br />3 Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other -- <br />CITY Of EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify Ihat I have read and examined �his applicalion and know ihe same lo be true and correct. Ail provisions oi laws and <br />ordinaces governing �his type of work will he complied wilh whelher specified herein or noL The granting of a permil does nol presume <br />�o yive authority to violate or cancel Ihe provision of any olher slate or local law regulating r,onstruction or the perbrmance o� <br />consir clion. That I am aulhor ze� by Ihe owner ol �his property �o pertorm Ihe work lor which application is made and I comply with �he <br />Sta�e ontr tors Law 1827 C and 2962q0 WAC. C <br />��� ��� n r� � i��� ,�n �-t �--� 1 � �,��.P � n�� <br />i�; l <br />/ <br />