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P`RMIT APPLICATII,N ►-�� � ,��,,, <br />CITY O� EVERETT PERMIT SERVICES N���y � <br />3200 CEDAR STREET, EVERETT, WA 98201 �� �� <br />425-257-8810 — FAX 425-257-8857 -- ww�� everettwa.o g <br />�sa �c� <br />APPLICATIONS ARE ACCEPTED FkOM 8 AM TO 4 PM - DE81i 8 CREDIT CARDS ARE�UT ACCEPTED <br />SITE ADDRESS <br />3 b_((�Z"'� pl� S u1• <br />LEGA LOT NO. BLOCK <br />oesc � N�I�i fa✓��, I <br />TRACT <br />PARCEL TAX I.D. # <br />)/j2. DOc�JO � D � <br />23 i�O 25n1 Q-UC. <br />�RMITp �`� / <br />(� �` <br />urvnen4�U�Z.'� ,TOHNSON AUPHt55 GITY/ZIPyd��JPMONE NZS <br />QuUEr soKNa HuM�%�F e��Rcir 3�2.3" 9(�t~ Ac. s C� �ER�rr y�o—Pb3� <br />L �-L <br />TENANTNAME ,/ CONTHCTFORPERMIT PHONE <br />_�r�J(L ��^� r I c�R i T�Kn►sonl �yLs� e�o —/b3o <br />CONTRACTOR ��Slq I LOMIJ�ta��-'�1 �DRESS <br />CONTR.L�CENSEp�/^�L7,�n �g��Y <br />V 7 �'` J <br />CITY2IP <br />25 �l(�� P� s � -R�rr <br />PHONE l�Z , � <br />l <br />,3y � �JC, � 87o��da <br />USE OF BUILDING HEAT SOURCE <br />�I�+Y'G /u��� l� ��NSL � �_[lectric �Ges_Othei <br />WORK DESCRIP710N <br />LDniff'��t N�u� <br />:ao. � <br />� �� �� /) �_,/ � � i�� � <br />PLUMBING <br />TYPE OF FI%TURE OR ITEM <br />a Toilel <br />� Bathtuh <br />� Lavatory (wash bnsin) <br />Shower <br />� Kitchen eink 8 disposal <br />��Ishwasher <br />Clalhes washer <br />_�___ Laundry tray <br />Slnk (service/bar/mcNetc.) <br />Backflow preventrr <br />Urinal <br />Dnnking Fount�in <br />Floor draln <br />Grease trap <br />�Rool drains <br />Olher _ _ <br />� <br />/�In?iL ��tM/I�/ <br />J � <br />/%✓ <br />CONTRACT PRICE OF WORK <br />JS,�do•va <br />I^Cli3���t� /�1���"`�S� <br />� <br />cr .i <;'-( �— / �{[% <br />NO. I TYPE OF FI%TURE OR ITEM <br />A/C - alr handllnp units <br />Farced alr syslems <br />Gas pipiny <br />Water heeter <br />Gas flreplace <br />Ges rarge <br />Clathes dryer <br />Range hood <br />Exhauattan <br />lieat pump <br />UNl hester <br />Boiter <br />Refrlgeiation <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL 9ALES TAX COUE 19 710F <br />I heraby ceritify Ihat I have read and examined Ihis epplicatlon and know thP sama to Setrue and corcect. All provislons of laws end <br />ordinaces goveming this type o( work will be complied with whether specllied hereln or not. Tha grenllnp of a aermll does not preaume <br />to give authonty lo violate or cancel the provision ot any olher state or local law rnyulaUn� consWctlon or the perfonnance of <br />constructlon. That I am authonzed by Ihe owner of lhis propsrty to per(orm tt.� work fcr which eppllcallon is made end I comply wlth the <br />Stale Contrpctcrs Law,�B.27 RCW and 296.200 WAC. <br />�ib<,� 1 aa <br />ace �%Z <br />