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P�RMIT APPLICATIC.�� <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 X Q9b�- �p� <br />SITE ADDRESS <br />17�7 129 �.SF <br />LEGAL LOT N0. BLOCK <br />DESC. <br />OWNER ` <br />�iGv� d (��cP��e <br />TENANTNAME <br />P! RCEL TAX I.D. p <br />TRACT OR SUBDIVISION p <br />CONTACT FOR PERMIi <br />PERMIT p <br />CITY2IP PHONE <br />PHONE <br />� E-MPJL <br />�-�U <br />CONTR. LICENSE p <br />USE OF BUILDING <br />WORK DESCRIPTION <br />HEATSOURCE <br />Electric Gas Othor <br />�n/��_ <% � � � <br />NO. � TYPE OF FIXTURE OR ITEM <br />__�_. . lbilel <br />.�_-_ �a�htub <br />_L Lavalury (wash b�sin) <br />Shuwcr <br />I Kilchmi sink & disposal <br />I Uishwashcr <br />Clothes washer <br />W aler ho�der <br />Sink (scrvice/bar/mop/ulc.) <br />Backllnw prevenlor <br />Urinal <br />Drinkinc� fouNain <br />Floor drain <br />-- Grcase trap <br />Rool drains <br />Olhcr <br />CONTRACT PRICE OF WORK <br />NO. I TVPE OF FI%TURE OR ITEM <br />_ A/C - air handling unils <br />Forced air systems <br />Gas piping <br />Waton c�aler <br />Gas liroplace <br />Gas ran�7o <br />Clolhes dryer <br />Rango hood <br />]` Ezhausllan <br />Heat pump <br />Unil hcater <br />8oiler <br />Rolrigoration <br />Woodslova <br />Other <br />CITY OF EVERETT IOCAL SAIES TA%CODE IS �105 <br />I hereby cenlily that I have read mid examined Ihis applicalion and know tho samo to bo Iruo and cortoct. All provislons ol laws and <br />ordinaces goveming Ihis typo o� work will bu complied with whelher spacilied horoin or nol. Tho granling ol a parmit does not presumo <br />lo �ive aulliority lo vioLvlo or c:�ncel Iho provision ol any othor state or local law rogulaling construction or Iho peAormance of <br />conslrucliun. Thal I am authori�ed by lho owner ol Ihis property to pedorm tho work for which application Is made and I comply wilh the <br />Slat� C�c�pUaclors �+ 78.27,RGW anA 29fi.200 WAC. �/ I� <br />� o/ e�l.., � l - - ./i%� /v il <br />