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P�RMIT APPLICATI(�N �,� � <br />CITY OF EVERETT PERMIT SERVICES N���� (�urJ�^� <br />32(10 CEDAR STREET, EVERETT, WA 38201 ��� � F <br />425-257-8810 — FAX 425-257-8857 — www,everettwa.org <br />�, �.��� -a� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PA1 - DEBIT lt� CREDIT CARDS ARE N T ACCEP7ED <br />SITF AODRESS <br />_L3�7 D 2"�� <br />LEGA LOT N4� � � <br />7ESC. 7 ��� y y <br />S_u/ <br />BLOCK <br />Y�IJLT SOun.N NOna1 07- <br />G ,�� tt �.. < <. ��, rT�,�, <br />TENANTNAME <br />G f •�i <br />oRL.N, , <br />COKTR. LICENSE M�D Jt TL a yB y�� <br />v� �� <br />USE OF BUILDING <br />i, � l� �`,�__, y fl��s� <br />WORK DESCRIPTION <br />loti��w�-/ <br />1��� ��b��] <br />PARCEL TAX I.D. I! F.kMIT� <br />OI ols 20r�ovv�,Jo � � <br />TRACT <br />z3 ,—�n 28 ,� ,�U� <br />rna�nc �yzj� <br />3Y�3 y�� , �� st �� <br />t37v—/63� <br />CONTACiFORPERMIT PHONE <br />CN �7 �ldti�s� � ( yz5 <br />ADDRE55 CITY2IP <br />3Y� ybrY /��st� ��� <br />HEATSOURCE <br />_ Elactdc �os _ Other <br />� f�7D—(63 a <br />PHONE yZ� <br />CONTRACT PRICE OF WORK <br />/�10j JU�. ✓ � <br />,Uc..,� f� l� �,�., /�, �i��s �c�<< , <br />� <br />('�� 1��, ..�;;t�)/�_ 1��� /Cr� ��3c�� <br />NO. TYPE GF FIXTURE OR I1EM <br />follel <br />Lavalory (wash 6asinj <br />Showor <br />Kitchon sink 8 disposal <br />Dishwasher <br />C:?Ihes wasl ier <br />Laundry Vey <br />Sink (servicett�ar/mop/etc.) <br />Backilow prevenler <br />Urinal <br />Drinking Founlaln <br />floor drain <br />Grease trap <br />Ro�� drai�s <br />Olher <br />N0. � TYPE OF FIXTURE OR ITEM <br />wl: — a�r nantlling unlis <br />�Forcod alr systems <br />Ges plping <br />_(_ Watar heator <br />� Gas ftroplace <br />I Gas range <br />�Clolhes dryer <br />Rangehoad <br />� Exhaustfan <br />Hoat pwnp <br />Unit healer <br />Boller <br />� Rafriperalion <br />Woodslove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE 13 7105 <br />I heraby conlify lhat I havo read and examined thls applicalio�� and know lhe came to be Irue end rartea. Ail provislons of iaws end <br />ordinacos goveming thls typa o� worF: wlll be complied wilh whether specified herein or noL The granUng of a pertnit does r�ot presume <br />lo givo authority lo violata or cancel Iho provislon ol sny ct`.r ,,;ate or local law regulating conslructlon or the per(oimence of <br />construclion. That I am authonzed by Ihe o�.vner of lhis pmperty to pertorm lhe work lor whlch applicatlon is made e iA I comply wilh the <br />Slate Con aclors La 1B. RCW anJ 296.200 WAC. <br />��_ �7,�a / z�, y <br />Signat reo70wner/ i acWd ulho io-c�gent ��e — <br />� 1/2 <br />