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P�RMIT APPLICATIc�N ��� � ,���, <br />CITY OF EV�RETT PEf�MIT SERVICES �I��ly U" <br />3200 CEDAR STREET, EVERETT, WA �8201 ,AL �� <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.o g � <br />����� <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE OT ACCEPTED <br />SITE ADORE55 <br />__(3pb - IUZ"'� <br />LEGAI LOT N0. <br />DESC. � N,�jly fi✓.�n� <br />8I OCK <br />vr�ntn Lu�j ,TOHNSON <br />put�Er soNNo Ho M�s oF e�Ea��r <br />L L-G <br />TENANTNAME I <br />�<c �M, l� <br />CONTRACTOR ��u 5 q f���1�•'� <br />CONTR.LICENSENCV�STLK�(/ I�S <br />USE OF BI.ILDING <br />�1^y�G- 7uMi �l <br />� <br />�✓NS� <br />WORK DESCRIPTION <br />Cd� y?��, �f <br />�� � i� --��� � � � <br />NO. I TYPE OF FIXTURE OR ITEM <br />.! Toilel <br />� Bathtub <br />% Lavatory (wash basin) <br />Shower <br />_(_ Kltchen slnk 8 dis�sal <br />�Dishwasher <br />Clothes washer <br />� Laundry tray <br />Slnk (service/banmop7elc.) <br />BeckOow preventer <br />Urinal <br />�nnking Fountain <br />Floor drnin <br />Groese lrap <br />�Foof dralns <br />Other _ _ <br />IPARCEL TAl( I.�, # — P RMIT# <br />DIDl32.�oduo�v� � � �'�%�l <br />?RACT <br />sca z) i�a zy�1 2(sE. c w <br />ADDRE55 CITY2IP!'��g PHONE Nz5 <br />3y� 9��� P� s.E- �E2�rT ��o-am.�o <br />CONTACT FOR PERMIT PHONE <br />C��t; <br />ADORESS <br />K �lso nl I <br />9�0 — /630 <br />C�TY21P PHONE <br />✓yZS Ci�i�" pl, 5-�- ��CI��T7 <br />HEAT SOURI:F <br />_ Electrlc �Gaa __ Other <br />N�,� F,�,�� �K,�;iy <br />�4 Z �) <br />970-�6; <br />CO�TRACT PRICE OF WORK <br />S,�oo�v� <br />res, s d��« <br />, <br />, � �� t�,t � <br />�. � <br />N0. � TYPE OF FIXTURE OR ITEM <br />NC – alr handlinp units <br />� 7 Forced aIr syetems <br />$ Gas plping <br />� Weter haeter <br />= Gas flreplace <br />�_ Gas range <br />J_ Clnthes dryef <br />� rtanpe hood <br />� Exheuslfan <br />Heat pump <br />Unit heeter <br />Boller <br />�Refdgeiallan <br />Woodstove <br />_� Other <br />CITY OF EVERETT LOGAL SAI.ES TAX COOE 19 7105 <br />I herehy ceritify that I hava read and examined this eppllcatlon and know lhe same lo betrua end correct. All provislons of laws end <br />ordinaces govem�ng this type of wcrk will be compliod with whether specified herein cr noL Tha granNnp af e permit does nat presume <br />to grve authodty to violate or cancel the provisior of eny other state or local law reguletlng coneWcUon or the paAormance of <br />r,onstn:ctlon. 7'!iat I am aulhorized by iha owner of thie prc,perty to perform tha work far whlch eppllcatlon ia mede and I comply wilh the <br />State Contr c,tors Law 1827 RCW and 286.200 WAC. <br />� . _ f c�y« J o0 <br />Signalur wner ontractodAut onzed c. ate �/� <br />