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P�RMIT APPLIC�4TIVN <br />CITY OF EVERE7T PERNiIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - •Nw.everettwa.org <br />SITE ADDRESS <br />Z 2'�-'� i3 I 1 b�''� �-r <br />LEGAL LOT NO. <br />DESC. I��� �S <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.G. t� <br />5t F� �i Gos"�a�oO�oc� <br />HLOCK TRACT <br />C <br /># <br />`I <br />,\n a V (oCio N�A� t- 222-'T f3 ���'�` s-r S� �� o a eiC- '� <br />TL'NANT NAME CONTACT FOF PIiRM1T PHONE <br />�,���ia� J�.; < <��'�R2�S S �i2s. ��1�_Z�_ <br />CONTRACTOR ADORESS CITY/ZIP PHONE <br />CONTR. LICENSE ll <br />USE OF BUILDING <br />12.25 � D�.N'� � n � <br />WORK DESCRIPTION <br />-I—U � •-1�r�'C � ^v w.� <br />HEATSOURCE <br />I�cUic Gas Other <br />-I-1,�n ��� -�w�S <br />PLUMBING <br />Np, I TYPE OF FIl(TURL OR ITEM <br />Toil�l <br />Bd��1�U�) <br />Lavatory (wash basin) <br />Shower <br />Kilchr.n sink 8 dis�wsal <br />Dishwash�r <br />Clolhes washor <br />Watcr healcr <br />Sink (sorvicolbar/mop/elc.) <br />Backflow provenicr <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roo( drains <br />Olhar _ <br />NO. <br />CONTRACT PRICE OF WORK <br />TYPE OF FI%TURE OR ITEM <br />NC - air handling u�iits <br />Forced air syslems <br />i�i05 �ll�ll(1(J <br />Waler heater <br />G�s lireplece <br />Gas ranyu <br />Clothes dryer <br />Ran9e hood <br />Exhaust lan <br />Heat pump <br />Unit he� Icr <br />Boiler <br />Ro(rigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />I hereby ceritify Ihat I havo read anA exemined Ihis applicalion anA know Ihe samo to be Iruo and correcL All provislons of laws end <br />ordinaces �ov�rninc� ihis lype of work will bo compliod with whe�her specified horein or nol The yraNing of a permit does nol presume <br />to givo aulhorily lo violalo or cancnl lhe provision o1 any other slate or local law regulalin� construclion or iho perlormance of <br />construction. That I am authorized by the o�vnar of Ihis property to pedorm thn work for which application Is made anA I comply with the <br />