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SITE ADDRESS <br />qo1 q�H+ Si�, <br />LEOA LOTNO. <br />DESC. �c� <br />�epu� Gb.�i�k.12 � <br />, _._ . <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br />PANCEL TAX I.D. • <br />00 UOL <br />BLOCK 7RACT OR 8UlDI.V�I1SION � <br />.00� B12o/1pW/r'� MM+�Y1. <br />S <br />qo I q�}�S�• SE <br />ICONTACT FOR PERMIT <br />L1.c�.Je K.I.eJCY1 <br />CaRT1f7�CT8N — � <br />� C� I'R O r_ �.. t'I <br />CONTR.UCENBER _. i <br />ar x <br />USE OF BUILDING <br />�IciP.�1 CCi <br />'�S C� <br />1ob- <br />PMONE ��, 7SL • I�I 0 Z <br />Io�B�N Si . I�L � ���.� �..,,,.�.r,.........•.,z, <br />� D23? S�k-�C.vIS �.o�o •7��� t �1aZ-. <br />9 82-5$ <br />HEAT 80UI10E <br />_ Elechic _ Gas _ Other <br />WORK DESCRIPTION <br />1�et�lau, ,.�-�d ..���1 ati c�� s-XtSi��r�c� j��C� � <br />N0. � TYPE OF fll(TUNE OR ITEM <br />� oilet <br />Bathtub <br />� � Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwashe� <br />Clothes washer <br />Waler heater <br />Sink (service�bar/mop/etc.) <br />Backl�ow preventer <br />Urinal <br />_. Drinking Founlain <br />Floor drain <br />Grease Irap <br />Roof drains <br />Other <br />CONTRACT PRICE OF WORK <br />�7f$S`(� .a0 <br />NO. I TYPE OF FlIITURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water hoaler <br />Gas lireplace <br />Gas range <br />Clothes dryer <br />Range hoad <br />Exhaust tan <br />Heat pump <br />Unit hoater <br />Boiler <br />Relrigeration <br />Woodstove <br />Olher_____. <br />CITV OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />I hereby ceritify Ihat I have read and examined Ihis application and know Ihe same to be Irue and correct. All provieions of laws and <br />ordinaces govoming Ihis typo ol work will be complied wilh whether specilied heiein ar nol. The grenling ol a permil does nol presume <br />to give authority to violate or cancel the provision o1 any other stale ar local law regulating conslruction or Ihe perlormance ol <br />construc�ion. That IyJ� auJho�rize� by Iho owner ol ihis property lo perlorm the work lor which application is made end I comply with Ihe <br />Bt e�OMraclois Ilai+ tY`37%' :W and 296.200 WAC. <br />'-ti r-oc <br />e��— <br />�2- <br />