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P`tRMIT APPLICATIVN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAF STREET, EVERETT, WA 98201 <br />425-2G7-8810 - FAX �25-257-8857 - www everet!waorg <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRE55 I PARCEL TAX I.D. A <br />_�� c';i �1��;r'h �I .Sc= /-�,,�•; l� O/�'7UG�'Uc�c�/ �c�G� <br />LEGAL l0T N0. BLOCK TRACT OR SUBOIVISION tt <br />7 ^ . <br />�,�'�C. � .��_ / ili �lv/_- ii� ��V�, c. �d.(,�-�%C�. <br />,�J���,"/' l" // C/L � c�iv i <br />T�NANTNAME <br />-, o�,_ �} S�G c 7- .S �_ <br />CONTACT FOR PERMIT <br />�Nil�, <br />� _S':�it '"'% ��e.:si= S /Ilr,�,,.c /'�%( 5 hp/r'r ,5/Y Z`Il <br />(i ciae l <br />GONTR. �ICENSE p � <br />_��.ti� �;�= �; a � �; ,� �?l�yl�o ��-.. _sM....,�,� ti <br />USE OF BUILDING �r HEAT SOURCE <br />J �� �,� J L" %-� n'� Q z J T�) '� _ Electric _ Gas _ Other <br />PNONE <br />�i �r�s � <br />REj2M1T U <br />.0 � � � — <br />'Y �� 7 - 3 � �/ -0 5 ?3 <br />.� W, <br />i Ani. c� /��.,�� , hc•.,;�,�, <br />,:��.5-33�E-a,7i <br />CONTRhCT PRICC OF WORK <br />� .} � G ��, i',�' <br />WORK DEaCRIPTION . / // <br />/J /�i�cic L /7i`r� .S (. <br />n 'i � 4..t .�i:,� .J ��lt'� I1G:,� /f['/eC.r j � <br />.'7 �' /-, <br />VO. � TYPE OF FI%TURf OR ITEM <br />Toild <br />-- Da1hIuL <br />Lnvalory (wash basin) <br />Showcr <br />Kilchen sin6 8 d::,pos�l <br />Dishwashcr <br />Clolhes w��h�r <br />-- Watcn c�alcr <br />Sink (service/Ladmop/elc.) <br />�acA'iow prevent�.:r <br />Urin,d <br />Drink��9 Founlain <br />f laur Ji ein <br />Grease ti.�V <br />Rool dra�s�, <br />Olhor <br />NO. <br />/71;�'_'�.�- �-� �x�r..% <br />TYPE OF FIXTURE OR ITEM <br />l��C - air handling units <br />Forced air systems <br />Gas pipinc� <br />Water heatnr <br />Gas fircplacc <br />G�s ranga <br />Clolhes drycr <br />Range hood <br />Exhaus�lan <br />He�lpump <br />Unil hcaler <br />Boilor <br />Relrigera;ion <br />Woodstova <br />CITY OF EVERETT LOCAL SALES TN( COUE IS 7105 <br />I hr.rol�y cerilif��� thal I have read and examined Ihis applicalion and know lho same lo be Irue and corrocl. .411 provisicns ol laws and <br />ordinaces govemin� this lype of work will be complied wilh whether spacified horein or not. Tha granli�g of a permit does nol prr.,ume <br />to �ive aulhority to v�olale or c�.�rol the provision ol any other slale or local iaw regulating consbuclion or Ihe pedormance of <br />r.onsiruction. Tha� I am authorizeo by iho owner o( Ihis propoAy lo perlorm Gie work lor which application is made and I wmply ,vilh Iho <br />Slale Conlraclors Liw 1827 RCW and'1.96 20U WAC. <br />� - � <br />_-�:�i.i'� ---- �� _cY_(� J � <br />SignaWre ol OwnerlCon�r�ctor/Aulhorized Ac�ont D�to � 2 <br />