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SITE ADORESS <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.evereltwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ���j - �� �/(` <br />--L-F— <br />PARCEL TAX I.D. U PER IT <br />S �� � _ 2Bas' /Boo3o3St�o L'- � <br />� N0. BLOCK TRACT <br />diT k 9 <br />R0.<£ Ff�MG'� �NL I IiOIe MK►RI Nt �R. M�Rvsr�i/� 9$27� 3I0• GS2'7S9/ <br />TENANT NAME r I CONTACT F9R PERMI PHONE <br />�:6X �ol�/ a/n 1GiY ...i�9TBPt sGn-bS�-7s3'/ <br />CONTRACTOR ADDRESS � CITY2IP PHO E <br />RoslE i�Mt�, %�� ii7oG MAR�a,� �R;vr, M,�wys✓ii/e l477� �H.Gs7-7�"!/ <br />CONTR. LICENSE M <br />Rnsr' u L *' n tJ� ,1 7. <br />USE OF BUILDING <br />WORK DESCRIPTION <br />HEATSOURCE <br />[loctrir, Gas <br />Olhcr <br />CONTRACT PRICE OF WORK <br />l..onLSTRU[T7'oN e� ,S.',J9f E�Mi y' �S� D bYGP ( p/��t/G> �A�s%c �'22Z <br />NO. I TYPE OF FIXTURE OR �TEM <br />� <br />-'[ — <br />;� <br />Tailol <br />�atlilub <br />Lavalory (wash basin) <br />Shower <br />Kilch�u sink 8 disposal <br />Dishwasher <br />Cblhes washor <br />VJal�r hentar <br />Sink (sarvic�lbarhnop/�tcJ <br />�ack0ow prevontar <br />Urinal <br />Drinkinc� Founlain <br />Floor drain <br />Greasc trap <br />Roo� drnins <br />Othcr <br />N0. I TVPE OF FI%TURE OR IiEM <br />A/C - air handling units <br />Forced air systoms <br />Gas piping <br />Water hoatFr <br />Gas liroplaco <br />Gas range <br />Clolhos dryer <br />Ranc�e hood <br />Exhausllan <br />Hcalpump <br />Unil heator <br />Boiler <br />Rolrigeration <br />Woodslovo <br />CItY OF EVERETT LOCAL SALES TA% CODE IS 7105 <br />I hereby corllify that I have read and ezamined lhis appiicalion anA know tho same to be Ime and corrocl. All provisions of laws and <br />urdinaces �ovorninc� Ihis lype ol work will bo complied wilh wholhar spociliod horain or nol. The granling ol a permil does nol presume <br />lo c�ivr, aulhority to vio�ato or cancol �ho provislon o� any olher s�ale or local law regulaling conslniclion m lhe peAormance of <br />construction. That I am aulhorizod by Iha ownor ol this property lo pedorm Iha woik (or which application Is made and I comply with lho <br />Stato CoNractors Law 10.27 RCW and 2�J�.200 WAC. <br />-�,�/N ���5% io-�ra6 <br />