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P`tRMIT APPLICATION <br />ClTY O� EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />y�� APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. p <br />.5-rU q5 T•� L�,�.,r r s• c= 260.�' i8�o�o.� y� <br />LEGAL GCd NO. BLOCH TRACT <br />DESC. UM� r �, � � <br />/lpst. �fz'd//65 �N[ <br />TENANTNAME <br />CONTRACTOR qs� N/Fy � <br />CONTR. LICENSE p <br />U,lt� ��. � � <br />USE OF BUILDING <br />�. � . �. <br />WORK DESCRIPTION <br />/ <br />PERMIT <br />ADDRESS S� 1''C <br />CITY2IP <br />98�7/ <br />� �g �o <br />:RMIT k <br />0 70 �v '�', � <br />3L-�'GS'L•7S7j <br />19:H121q <br />3 [�a - G,S"L -7� `/� <br />PHONE <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />Eloclric ✓Gas �)Ihor <br />�o�v�r�Purr:oN a/= �S�'Ny�E �'r/�1.� �s:pErvtE (��s,�'r2/fJ <br />PLUMBING <br />N0. I TYPE OF FIXTUH! OR ITEM <br />� Tail�l <br />� Balhtub <br />4 Lavalory (wash basin) <br />% Shower <br />i_ Kilchen sinY, R disposal <br />_/ Disliwaslior <br />J_ Gothes washor <br />�_ Walr.n c�alor <br />— Sinh (scrvice/bar/mop�otr,.) <br />_ Dackllow preventcr <br />Urinnl <br />- Drinkiny Founlain <br />Floor drain <br />- Groase Irap <br />� ftool drains <br />Olh�r <br />NO. I TVPE OF FI%TURE OR ITEM <br />�— AIC - air handling units <br />� Forced air sysloms <br />� Gas pipin� <br />� Watorhoatcr <br />— Gas liroplaca <br />�� Gas rango <br />� Clalhos dryer <br />_tJ_ Range hood <br />�}_ Exhaust (an <br />Hcal pump <br />Unit hcator <br />Boilor <br />— Rolriyoralion <br />Woodstove <br />— Olher <br />CITY OF EVERETT LOCAL SALES TA7f CODE IS �105 <br />I heroby coritily Ihat I havc� read and ezamined Ihis application and know Iho samo to bo truo and corroct. All provisions of laws and <br />orrlinaces �oveming Ihis lypo ol work will br, compliod wilh whethor specifiod heroin or not. Tho granting ol a permit does nol presume <br />to givc aalhority to violato or canccl thu provision ol any other state or local law regulating conslruclion or thu poAormance ol <br />consirudion. ?ha� I am auUiorizod by tho owner ol this property to pedorm lho work lor which applicalion is mado and I comply with Ihe <br />Stale Con�Wrs Law 182 CW and 296200 WAC. / <br />�I.//6� .Ef � /9�7 <br />Sic7nalure o( OwnodConlraclorlAulhorilod Agen� Dala �� 1 <br />o� <br />