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SITE ADDRESS <br />2W 0 <br />LEGAL LOT NO. <br />nesc. �� (p <br />PtRMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 38201 <br />425-257-8810 — FAX 425-257-8P,57 — H�ww.everettwa.org <br />APPLICATIONS ARE ACCEPiED FROM 8 AM TO 4 PM <br />BIOCK <br />PARCEy� 'AX 1.0. # <br />�C3 b S)�% 0 U 3���f � tr'� <br />S UGZ'OS <br />� <br />! �'v' � . i ,i <br />PERMIT # <br />C' � �.a - <br />�' � <br />� <br />OWNER ADDRESS GI7V/ZIP PF10NE � 7.� _ <br />il C i��j- t'.F'l "i-Y ��/�ti. `� �� �ll ;h �j )1F '� I `�t )hiQ �i ��`6z`10 'i �70' C�114�� <br />TENANT NAME I CON7ACT FOR PERMIT ' PHONE ' <br />. � , .� <br />., t i % ' �� � � • • <br />COp1TRAC70R <br />Jn�C��f�<' � 1 I ��nii"> <br />CONTR. LICENSE p <br />USE OF BUILUING <br />WORK DESCRIPTION <br />��� �%�� St � � U � ) <br />NO. I TYPE OF FIX7UHE OR ITEM <br />3 Toila� <br />�Oalhtub <br />Lavalory (wnsh basin) <br />�__ Showor <br />j_ Kilchun slnk 8 disposal <br />L Dishwashcr <br />I Clolhcs washnr <br />� Waler honlnr <br />Sink (sorvico�hadmo�dcic.) <br />�ackllow preventr.r <br />Urinal <br />Drinkiny Founlain <br />Floor dr�in <br />-- Grease irap <br />Rool drains <br />Olher <br />ADDRESS <br />) �'' `�l `�C <br />HEATSOURCE <br />CITY2IP PHONE �--�Z ��- <br />1 . . � �' ' � !i' f. <br />�Nbf{ `1�j1�1v ��3p Dyl�4 <br />I CONTRACT PRICE OF WORK <br />_ Elr.c�ric �_ Gxs _ Olh�r <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />A/C - air handling unils <br />Forced air syslems <br />Ge� piping <br />ltialer healer <br />Gas lireplaco <br />Gas rango <br />Clolhes dryer <br />Rangohood <br />Exhaus�lan <br />Heat pump <br />Unll heater <br />Boilor <br />Rofrigoralion <br />Woodstave <br />Olher <br />CITY OF EVERETT IOCAL SALES TAX CODE IS 7105 <br />I horrby coritily Iha! I hove road and exominod thls applicalion �nd know iho samo to be Irue and correcL All provisions of laws and <br />orAinaces �ovemin9 Ihis lype ol wo�k will bo r.omplied with wholher speciliod hernin or no�. The yranliny ol a permit does nol presume <br />to pive �uthority lo violate or r.ancel ihr. provision of any olher stale or local law regulating conslruclion or the pe�formance oi <br />conslru�tion. Thal I am eulhoriz�d by Ihe owner of this property to padorm ihe work for which application is made and I comply with the <br />Sla�e Conlrar.lorg,Mw 18.27 R,GW and 296.200 WAC. <br />�� �' <br />c <br />1I2 <br />