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P�RNiIT APPLICATIO�� <br />C�TY OF EVERETT PERMIT SERVlGES <br />3.^00 CEDAR STREET. EVERETT. WA 99201 <br />41:�-Z�i7-[i810 - FAX 42`i 257-EE15' www.evcretiwa org <br />I'.PPLICATIONS ARE ACCEPTED FRC M 8 AM T�) 4 PM 3_\g` �/ <br />------------------ ___— -------- --------- <br />SffE ADOFIESS FARCEL TAX I.I). k � PER�dIT # <br />�l,o._ <br />i3 P/, s,,.� �CX��`12 _3 U O C� � cxl � i _—i-S�i'�. �' U G'� � I <br />LE3�� LOT NO.— � BLOCK �� A� OR,SU9<D`I/V�� �ON� � <br />OESC ,' �j wNl.� ____ <br />OWNF.R AODRESS CI7V21F PHONF <br />--^,��'��r1_�'-�._ ��=---�2(o%j'L_��u,�c _�'.f.i' �I Cr!/� `7�'1�?J N2sZ12zy�1 <br />TENANT NAME COMTACT FOR PER�IT PNONE U- 2�3��' �� � <br />�-/»i1�1%r %✓.'NC E•MAILI�,v<f,��� s tl!'u.1t�i,-..�`• <br />� -- h6�ik�5�---- ---�ZD� �Rbia"�� - - <br />1�/�LJ i���.) IJ�NI. 2� S �i.�/�.ir 1�YC, (:I�JUIJ L� /ivL NVV l�' 3i! 3 S�c•/7F��.vi v�r1 r'1�/%% <br />CONTR. LICENSE p I <br />�)aw s�,�.2 ��_a� 6 � _ <br />USE OF BUILDING <br />Ne r,� _�/i +,1 <br />WORK DESCRIP?ION <br />�/t' VV <br />I HEATSOURCE <br />I_ Electric _ Gas __ Olher <br />—_� _ <br />/l,�ir+� - ��?,L �i� �y - 134,1.�4' <br />� ) �� . 4a�' � <br />PLUIVIBING <br />TYPE OF FI%TURF OR ITEM <br />I�idetlll <br />1 ,fll�luhl` <br />I;ivatory (wash basin) � � � <br />;hnwcr <br />VOlrhr.n sinF. 8 dlspos2l <br />DitihWashP! <br />Clolhes washer <br />Waler hoater <br />Sink (sorvice/bndmoplotc.) <br />Bar,kllow ,�rovenlor <br />Urinal <br />Drinking Fou�lain <br />F loor drain <br />Greasr ira�� <br />Rnof drains <br />OIhRf _ _ _... _ — . — .._ <br />�� _,�,�zo <br />CONTRACT PRICE OF WORK <br />_������ C <br />ECHAiJIC <br />TVPE UF FIXTURE OR ITEM <br />A,C - air handliny unils <br />Forced air syst�ms 1 <br />Gas piping <br />Wiler healer � <br />Gas lirepla�e <br />Gas range <br />Clo�hes dryer <br />Ran9e hood <br />E*hausl fan �I I j <br />lieal pump <br />Urut hc2tcr <br />Roile.r <br />Rclrigeration <br />�Voodstove <br />Olher <br />CITY OF EYERETT LOCAL SAlES TAX CODE IS 3705 <br />I hereby ceritify that I have read and examined this appGcation and know the same lo be true and correct. All provisions of laws and <br />urdinar,es 4overning Ihis lype of work will te complied wdh whether specihed herein or not. The grenling ol a permil does nol preswne <br />Io gWe :�ulhonly lo vielalr, or cancel �he proaslon ol any other stale or local law myu�ahng construction or the peAo�mance of <br />r,unslrucliun Tha� I am aulhorized by Ihe owner of Ihis property to pertorm ihe worh lor which application is made and I cqmply with �he <br />5ti;d2+�Conlractors Law 16.17 RCW anA 296.200 WAC. <br />, <br />i'� a��----- <br />Y.0 , lure u� �7wnri ('�,nh �� i,r�l�nlh��•Crd AgSnl Date <br />� � '> <br />� ', �.��-irt - � � �': ., ��� <br />