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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everetiwa.org <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br />SITE ADDRESS I PARCEL TAX I.D. p <br />!r�i�� �i�LTH ;� �c, � ��o4�lLKo�lo�� �ai <br />LOT NO. I BLOCK I TRACi OH SUBDIVISION M <br />4r- �vil_n.�,i �A,u.,,.•...�r— <br />PERMIT p � <br />(�--1_`�i 1 "1 �i ' � Z. � <br />�`vmr�1 th.rH � rn 5 o F= 4�k � c R-r �v r't'1C ��� �l'� C--�!<�;' /r� 96 ?�4^ <br />TENANT NAME CONTACT FOR PERMIT PHONE y,7j =�ct _ 37Q� <br />/JIJ�� c R� r}t,r,}L/N/R-�k_'�rvla� Cf�AF-'�_r1 /-'llctSi E•MAIL <br />iR <br />J i'- �h:'�r� r/' c�cw�.� f'�9 • �',1:�( ��i c,`� R =tiytTu u,N- Y"k!� V 2t!G� -�(�,, 7�,$T�L� <br />CONTR. LICENSE M <br />USE OF BUILDING <br />n�,.�r,�i.��//>.r.�� JI� ���i� <br />WOAK UESCRIPTION <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />_ _.NeclnC Gas O�her �<�jC"'� ��-� <br />�ti��a7�-Zf l�,�.(L�i.•r T'`S/4Tf}ti!i" l7�l11� i'f���.'Tl%kJUS t�jNtL /'A-Iv�L � <br />NO. I TVPE OF FIXTURE OR IiEM <br />1 oilei <br />lia�h�ub <br />I avntory (wash basin) <br />$hOWCf <br />Kiichr.n sink R dis�me�nl <br />ILshH�ishcr <br />C;IOIIICti W7SI1Cf <br />Walri hcaler <br />tiink (sorv�cc/badmop/alc.) <br />tlachllaw prevenler <br />Urin:d <br />Urinkinc� Founiain <br />I-loor drain <br />G�catic trap <br />Hnnt drains <br />Olhor <br />NO. I TVPE OF FI%TURE OR ITEIA <br />NC �� air handling um�s <br />horced mr sys�ems <br />Gas pipinp <br />w81Cf hCdlCf <br />�i85 �IfCj11�CC <br />Gas ranc�e <br />Clo�hes dryer <br />H;fngc hood <br />F.haust lan <br />Hea� pump <br />Unit hcaler <br />l3oder <br />Heingmalian <br />Woodslove <br />Oitiei <br />CITV OF EVEREiT LOCAL SALES TA% CODE IS 7105 <br />I hmeby cenUfy Ihal I have read and eMamineA Ilus a�nlication and know Ihe same to he inm and wrrect. All provisions ol lavre and <br />o�dmaces povemine� Ihis typ^ of work will be comphed wilh wheth�r specihed hmmn or not. The granUng ol a permil does noI p�esume <br />lo �rve aulhonty lo violate or cancel Ihe prowsion ol any other state or local law ieguiating constmction or Ihe pertormance ol <br />conslruction. Ihal I am aulhorireA by U�e owner ol this property lo perform Ihe work �or which applica0on is made and I comply with Ihe <br />Slalc ConVacinrs Law 182ZHCW and 296200 WAC <br />c ) <br />� l u` . ,.,t _ j�1� � 1n��'> <br />Signatwe ol OwnerlCoNractad n�ed Agent Dale � � <br />�Z <br />