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SITE ADDRESS �,�� <br />/Si S � <br />LEGA4 LOTNO. <br />D� — <br />OWNER <br />�%Acic /N �� <br />TENANTNAME <br />/N /�O <br />PERMIT APPLICATION <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 y_a y�-�%� <br />,vv Sj- <br />CONTRACTOR � <br />�;ONTR. LICENSE p <br />PARCEL TAX I.D. q <br />� �so2b'os-Y-Ob`f <br />BLOCH TRACT <br />AODRESS <br />�330 �u/� ,/�r�e , Sah <br />CONTACT FOR PERMIT <br />���-,� �/;��G� <br />ADDRE55 <br />�iil�C' �X C���� <br />USE OF BUILDING <br />Fo.s�i�oo .PPsfeavn.ti{ <br />WORK D CRIPTION <br />. .� a y,H, s <br />hEATSOURCE <br />Eloctric _ Gas <br />-0002 LLlZ <br />omer <br />P6RMIT # <br />�, �r o ? � � <br />yo, � C�s�) s7�-ass-� <br />2.3 'Z� PHO�€60 -% J � I <br />360- bo1-3z3i c�.e <br />CITY2IP PHONE <br />I .ONTR PRICE OF WORK <br />//97�v�vr D� �r•��Ny Fooryl ~"' �S�vuoru S <br />.� <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilcl <br />Balhlub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Wat�r healcr <br />Sink (service/badmopielc.) <br />Backflow preventer <br />Urinal <br />Drinkin� founlain <br />Floor drain <br />Groasr.trap <br />Roof drains <br />Othcr <br />ECHAN <br />S � �C7l� <br />eriHf �X <br />N0. I NPt OF FI%TURE OR ITEM <br />A/C - air hanc.iing units <br />Forced air systoms <br />Gas piping <br />Waler heater <br />Gas fireplacc <br />Gas rango <br />Glolhes dryor <br />RangehooJ <br />Exhaust tan <br />Heal pump <br />Unit iu:ater <br />Boiler <br />Rofriyeretion <br />Woodstave <br />Olher <br />CITY OF EVERETT LOCAL SAIES TAX CODE IS J105 <br />I hereby cerilify ihat I have read and examined this application and know th� same �o bo true and correcL All provisions ol laws and <br />ordinaces governinp Ihis lype o( wurk will be complied wi0i whelh�r specified hor�in or nol Tho granting ol a permit doos nol presume <br />lo give aulhority lo violate or canr.el Ihe provision ol any olher slate or local law rec�ulating consWr,�ion or the peAormance ol <br />conslrucliq Tha� I am aulhorized by Ihe owner ol this property to perform Iho work for which applicalion is mado and I comply with the <br />Slalc Cafilr clors L• 1827 RCVJ and 296200 WAC. <br />��-- 3 � v 6 <br />� nature ol Owner/ConlracloNAuthorized A�enl Dato �/L <br />