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, �� <br />i J�c'',-L ��� � <br />SITE ADDRESS <br />��� <br />LEGAL lOTNO. <br />OESQ '� <br />OWNER <br />CEo14iz l� �lL <br />TENIWTNAME <br />u�� <br />CONTRACTOR <br />( ' <br />PERMIT APPLICATION <br />CITY OF EV�RETT FERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everetlwa.org <br />�4PPLICAT10N3 ARE ACCEPTED FROM 8 AM TO 1 PM <br />BICCK <br />n7 v�,3z"M�h' <br />TR/1CT <br />PARCEL TAX I.D. K <br />�'SDfc00/ Op(oOZ <br />PJ�CTS <br />* <br />ov- <br />- g33Z 4� sr. S�E; GEe�r, `�s [4�s�4�-os�� <br />fONTACT FOR PERMIT <br />B,� 'Po��� <br />� }���._ INU, ADDRE89 'Yj��Z <br />CONiR. LICEN9E //1r D� �N � 95�0 /� <br />Ui <br />USE OF BUILDINO <br />Si�/Gt� -%.a, � <br />WORK DESCRIPiION <br />�o n1 cT2.V cT� o I� <br />C.0.6. $As�c-, <br />HEAT80URCE <br />_ �ledric � Gas _ Other <br />OF S, aG�LE C-�w� � w �res i flE.NCE <br />� ZtZ <br />NO. I TYPE OF flXTURE OR ITEM <br />Toikl <br />Be1Mub <br />Lavatory (wash besin) <br />Shower <br />KMchen sink 8 disposal <br />Dishwasher <br />Cbthes washer <br />lsundry tray <br />Sink (servleelbar/mop/etc.) <br />Badcllow prevenMr <br />Urinal <br />Drinking Fountain <br />Floordrain <br />Grease hap <br />Roof drains <br />Olher <br />PHONE <br />� Ti� q-ZZ - �S� i� <br />9Q�HONE �� <br />CONTRACT PRICE OF WORK <br />1"►D� oop °C-' <br />NO. I TYPE OF FlXiVRE OR REM <br />nn: — av nenaunp unia <br />Forced ak systema <br />Ges piping <br />Water heelei <br />Gm Rreplace <br />Ges renge <br />Clothes dryer <br />Renge hood <br />Exhaust lan <br />Heat pump <br />Unit heater <br />Bdler <br />Rafdgeration <br />Wootlslove <br />Other <br />CRY OF EVERETT LOCAL SALES TAI( CODE IS 7106 <br />I hereby ceritlfy Ihat I heve read end ezamined thy applicatbn e� know the seme lo be We and corted. All provleiona of laws end <br />ordinaces goveming this type ol work wlll ba complied wNh whether apeGfied Mretn or not. Tha grantlng ol a permfl doea not prosume <br />to gfve authorify to violate or cancel Ihe provision o1 any olher stete or local Iaw regulalinp wnstructlon or tM parlortnance ot <br />consWction. That I am authorized by Ihe owner of this prope� �.� lo peRorm the woAc lor whkh opplicatian is mede and I tomply with Ihe <br />State Con ors law 18.27 RCW and 88.200 WAC. <br />�i�� _ . � Ob �lt O � <br />/Z <br />