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SITE <br />0 <br />c��� 1 �'E; � <br />LOT NO. <br />� 03 <br />P�RMIT APPLICt�TIUN <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 />� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �"��� J-� I•a � i v <br />PARCEL TAX I.D. A' P,t'jRMJ1I �_�, <br />,�r". 2�oS� �c� ��US�d c,`>�` � <br />BLOCK TRACT <br />SS ooZ- U�" <br />wnnnccc CITV/lIP PH(1NF i� n: � <br />C'i �t�C'� 1 iiL*�'Y\Y"� �� �U�� �� lr„>T `[ )N6 �� `1�19L� <br />TENANT NAME CONTACT FOR PERMIT <br />• . • •� . <br />CO TRACTOR <br />(l�< <>��;��.� {-�'�i�-:' ,� <br />CONTR. LICENSE p <br />_�l1'l'�IiS���i�llt� _ <br />USE OF BUILDING <br />� j-�-� <br />WORK DESCRIPTION <br />�1 F;' /��, �� <br />ADDRESS <br />,i_-3 1 t „ . , j . ,t. <br />HEAT SOURCE <br />__ Fler.lrir, �. G�s _ <br />NO. I TVPE OF FI%iURE OR ITEM <br />_� Toilot <br />��athlub <br />Lavalory (wash basin) <br />� Showr,r <br />Kilchen sink 8 disposal <br />T Dishwashor <br />L Clo�hos washm <br />�_ Waler heator <br />_ Sink�sorvic�NadmoplcicJ <br />_ Backllow provenler <br />Urinal <br />_ Drinking Founlaln <br />Floor dmin <br />Greasa Irap <br />Roof drains <br />Olher <br />3��0 - �uu� <br />PHONE <br />• � " , <br />C1TY?II' PHONE y Z- � — <br />t..� . , . • � • <br />'�nl�el4��Ib1'�c 3�G �44� <br />I CONTRACT PRICE OF WORK <br />011lnr <br />NO. I TVPE OF FIXTURE OR ITEM <br />A/C - air handling unl�s <br />� Forced air systems <br />`t Gas piping <br />__/_ Watm hcater <br />_1_ Gas lireplar.c <br />_./. __ Gas ran�e <br />_.i _ Clolhes dryer <br />%, Ranc7e hood <br />� Exhausl�an <br />_ Heal pump <br />Unil heafor <br />Boilrr <br />__ Reingeralion <br />WooAstove <br />Olher <br />CITY OF EVFRETT LOCAL SALES TAX CODE IS 7105 <br />I hereby ceritify that I have road and evamineA Ihis applicflli;.n and know ihe same lo be lrue and correcl. All piovicions ol laws anA <br />orAinaces governine� ihis type o( work will be complied wilh whelher spc�cilied herein or not. The granting ol a permit does not presume <br />lo �ive aulhonly to violate or cancel lhe provision o� any other stale or lor.al �aw regul�linq construr.tion nr the perlormance of <br />r,onslruction. That I am authonzed 6y Iho owner ollhis piuperty to perfnrm the work for whlch application is made and I comply with the <br />Slale Conlraclor 18.27 CW and 296,200 N'AC. <br />^ � <br />�/� / r�./`� J 1� � C �..+ <br />�ignaWre o wnedCoMra tor/Authonzed Adenl ate �'Z <br />� �/ - - - - --- - ---- ---- - ---- -- I .__--- <br />