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�rERMIi APPLICATIvN <br />CITY OF EVERETT PERIVIIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM <br />SITEADDRESS �j n� �� <br />�6� - � 0 <br />LEGAL LOT NO. BLOCK <br />S <br />TENANTNAME <br />PARCEL TAX I.D. p <br />Oo ���da0a /Unpn <br />TRACT OR SUBDIVISION p <br />�a--g-�d <br />PERMIT p <br />2 <br />/" <br />507�- �� � �G,� �L�P/Y%T %�<03 y2S 7�.5����? <br />nCONTACT FOR PE IT PHONE (�7j�33p�?�23a <br />/-�.��2r/ �/%d�/hAll .....�� �Y2in./ i�l..�,,._ /l� <br />GVF111<AGIVR NUUI(CJJ NITILIY YI1V�'1C <br />_`a�t,�i�eU�„��n/ .ti�/Kf,n�� ='3%'G-�Z��ri9�SC Ev��^p7T5�'�''� ����,2�90 <br />CUNTR. LICENSE p� a ����5 /S� � / / <br />cJ <br />USE OF BUILDING <br />/°< <�j I i� t'i 7! C' . <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />Tuilr.l <br />_ Oalhtub <br />_ Lavatory (wash basin) <br />Sliowor <br />Kilc�mn sink R dispusal <br />_ Uishwashcr <br />_ Clu� ics washer <br />_ Walerhoatcr <br />-- Sink (sorvimlbadmop'olc.) <br />Uackllow prr.venler <br />Urinal <br />DrinY,ini� Founl:nn <br />Ploor drain <br />_ Groas� irip <br />Rool drains <br />O�her <br />HEATSOURCE <br />_ Eleclric � Gas <br />CONTRACT PRICE OF WORK <br />�� <br />Olhcr � l,� � <br />N0. I TYPE OF FI%TURE OR ITEM <br />__ A/C - air liandlin� units <br />Farced air syslems <br />Gas pipinc� <br />Walor hoalor <br />� Gas (ireplaco <br />Gas rango <br />Clothes dryor <br />._ Ranc�o hood <br />Exhaustfan <br />Hoatpump <br />Unil liealor <br />Boilor <br />Rolrigoration <br />Woodstove <br />Olhor <br />CITY OF EVERETT LOCAL SALES TA7f CODE IS �105 <br />I horoby cerilify that I havo road and examinod lhis application and know tho samo lo bo Iruo and correcl. All provisions ol iaws and <br />ordinaces governin� this typo of work will �o compliod with whelher spociliod herein or nol. The granting ol a permit does not presume <br />to give auUiorily to viola�e or cancol �ho provision ol any other stato or local law regulating c�nslruclion or Ihe periormanco o( <br />conslructioa That I am aulhorized by lhe ownor ol ihis prop�Ay tn partnrm lhe �vork lor which applicaliun is made and I comply with lhe <br />State CoNraclors Law,18.27 RCW nnd <"�u.Z00 WAC. <br />� � � ��/�� <br />/ J <br />� . �..."''^ ""_"_in..�ti_.:_..w n....... n.,�,. <br />