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I SITE ADDRESS <br />�ecn� /�� <br />UES(L � i.T 7 <br />ti-'tvc,.,�l" .� <br />TENANTNAME <br />� �t :�,� <br />� ....�.��.......��f�c. <br />'i CONiR. LICENSE p , <br />� USE OF BUILDING <br />i S(;) <br />I ':rORK DESCRIPTION <br />I <br />PERMIT APPLICATION <br />CITY OF EVERETT PERNIIT SERVICES <br />3200 CEDAR STR�ET, EVERETT. WA 987.01 <br />425-257-8810 - FAX 425-2E7-8857 - www.everettK�a.org <br />APPLICATIONS ARE ACCEPTED FROM 8 HM TO 4 PM <br />PARCEL TAX I.D. tt <br />���i��.i' � Q�U LFSI»3C: c.t:;4 �vlc, -c>u <br />BLOCK TRACT OR SUBDIVISION 11 <br />SP �zOZ z�i—O� <br />ADDRES9 CI7YlZIP <br />� �,I I 1 <br />�J Ca.� ��U1n�_��_� �I�l Ii✓''•. ��1__�L,I�.I1Cl. <br />CONTACT FOR PER IT PHONE <br />' ' I I<UC� �C�r,�l�� �. . <br />E•MAIL <br />1-IU•�� � s v� <br />LGr ��'. �' <br />y—��`� <br />C7� qo �!-vlI <br />PERMIT # ' <br />� <br />_�� ` i� � <br />PHONE <br />y�� 13�,- ,�, � <br />� � <br />yz� z3�,-S�i�}� <br />��— � '. ' .. � i <br />"?�nti> A-�-1� _ ' . , YCS 2gi �t�kw <br />� ,. , � <br />G,L � �'t �� �`'1 L �•�(i �i'f.ic+.1 ^�N <br />------ — `i7��>- <br />HEAT SOURCE I CONTRACT PRIGE OF WORK <br />Flectric �Gas __ Olher <br />/( i��� _� ) lli Sc� <br />--- -- - --- --- --- <br />i PLUMBING <br />�� NO. TYPE OF Fl%IURE OR ITEM <br />I <br />'—_—__._____ __. .. _ ._ .'— <br />_ _ lud�rl <br />fi411�11U�) <br />� d- Lavatory (wash basin) <br />—� Showcr <br />i I_ KAchen sink 8 disposal <br />�, Dishwashm <br />� Clolhes washer <br />� N'alor hoatcr <br />' � Sink (servicelbarlmop/etc.) <br />� �ackllow prevenler <br />Urin�l <br />Drinkinq founlain <br />Flour drain <br />Grease lrap <br />Rool drains <br />Olher <br />��I C�Uv <br />� <br />� <br />y�[J (� .,�-%} l i��Rc2 <br />MECHANICAL <br />TYPE OF FIXiURE OR ITEM <br />��C -.�ir hanAlmu unds <br />FOfcticl Bif Sy51e171S <br />Gas p�ping <br />Wa�er heatm <br />Gas lifeplaCe <br />' Gas rangc /� <br />Clolhes dryer `� Il l��' <br />Range houd / � <br />Exhauslfan U1 <br />Heal pump <br />Un11 heater <br />Boilcr <br />Refrigcration <br />Wouds�ove <br />Olher <br />CITY OF EVERETI LOCAL SALES TAX CODE IS 3705 <br />I hereby ceri�ity Ihal I have read and examined this applicalion and know lhe same �o be lrue and corred. All provisions ul laws and <br />ordinaces guveminc7 this lype ol work will be compGed v:ilh whe�her specilied hmein or not. The granlmg of a permit does not presume <br />fo yrve aulhorily to wol,ato or cancul Ihe provision ol any uther statc or local law regulating wns�ruction or the pednrmance o1 <br />conslruGOat-Tha I am aulhorized P Ihe owner ol ;his property �o perorm tho work lor which application is made and I comply with �he <br />StalF�Conlreclors �w IE3.27 n 1J6.2 � <br />� I <br />Signaturu o� Own dC nlr odAu�honz d Ac7eN _/ Dale <br />`'l' <br />