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PERMIT APPLICATION <br />CITY OF EVERE'1-f PERMIT SERVICES <br />3200 CEDAR STREET, EVERE:TT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 -- www.everatiwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ��,J �� U�� 1� <br />SITE ADDRESS PARCEL TAX I.D, p PERMR N <br />, �,, ���Z�� � ���J �, �,,.,, , �� , C' � o; _ r�,: <br />LEGAL I�QT NO. BLOCK TRACT OfI SUBDIVISION 1 , <br />DCSC. �/l� ;( � , . . � � .. � �� .,.<</r'. � ,i�" (�t���� . <br />�' �- �' � � ✓�� I 4 � c �:.:�r `iPZri i��5 1 i7 zzt�� <br />,•. ��� �� � � <br />TENANTNAME I COMACTFQRPERMIT PHONE �.i I,!'•� ' i%) ip i'�`=- <br />� �_ E-MAIL -' .. (�.� .�.mut �6<�. <br />�Z�A�A�idA � � � � ... . r', � t , � � .. E .. i <br />� � <br />.�, V � � � �. � r. . t., <br />�' � � . �.•. '. <� -... . <br />CONTR. IICENSE p ; . , <br />r . l � � � ' .' r �� . <br />USE OF BUILDIN6 <br />, I ,�, �, <br />� . <br />� � ��,r. <br />WOFK DESCRIPTION <br />�,, , �r ,. <br />It .Y��' ' , <br />HEATSOURCE <br />Eleclric Gas Otner <br />, , , <br />N0. TYPE OP FIXiURF nFl 17FM —_ — NO. <br />Toitel <br />'�� Ba�ht�d� <br />... T � Lav�lory (wash bcasui) <br />�r� � � Shower <br />Kilchen aink A d�sposai <br />�ishwast�er <br />Clothos wasf ie� <br />�i W�tor he2ter <br />Sink (servlce4:admepK�,�. 1 <br />' Backllowp�evenier <br />Urinal <br />Drinkinp Founl2in <br />Roor drsin <br />Gieoso Irap <br />Rocl dr,ins <br />OI I �:,� <br />., i <br />I CONTRACT PRICE OF WORK <br />TYPE OF FlXTURE OR ITEM <br />NC - air handling units <br />y Forced air systems <br />G2s piping <br />' Watar hoaler <br />Ges lireplaca <br />Gas range <br />[ CloUiee dryer <br />� Ranpehood <br />.� Exliaust fen <br />Heal pump <br />Uni� hAator <br />Boiler <br />Rofrigaration <br />Woodstovo <br />- - � Other---------- <br />CITY O'� EVEflETf LOCAL SALES TA%CODE IS 3105 <br />i I hereby ceritily Uiat I have read and examined ihis application end kirow Uie same ro be true ard correcl. All provisions ol IaNs and <br />' orAinaces goveming Ihis lype ol worh will bo complied wilh whether speclfieA herein or not. The gran�ing o( e permll does not presume <br />iiu give au�ho�ity lo violete or cancol Ihe provision of any o�her stete or local law regula6ng conslruction or !he performance of <br />consUuctlon. Thet I am authorized by �he owner ol this property to perform the work lor which application is mede and I wmply with ihe <br />i 61ete Coniractors Law 1827 RCW ancl 296.200 WAC. <br />I <br />" �� �,, <br />�::ignetur�e ofswner antredor/ ul ionze pent at I� <br />I L <br />�/ <br />l . � � � o <br />� <br />