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SITE ADDRESS <br />�:i <br />� • 1 : <br />I FGAI LOTNO. <br />�[SC. � i <br />PERMi�' APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STRE[T, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-251-8857 — w�nva.everetiwa.org <br />APPLICATIONS ARE ACCF_PTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. p <br />� '� �� i�, � . . . � <br />BLOI:K TRACT OH SUBDIVISION R <br />, � I. , . , . i i . <br />„„ I, <br />7 - 7�0 �Oq <br />EH ff X <br />�/� i/ ��7_ -/ <br />� „� ''�,.1� <br />� ����� '�� ��I,il � .��; I';��`.�i�b' ��4 � I . �,.�li�i��i�� �ii5 jl% l��'-' <br />TENANT NAME � CONTACT FOR PERMfT PHONE . i,_ i" ��', i: r�,: � <br />�.�i, ��i'b'i� E-MA�L l.r�i���, <br />\�,. (��� I�.�, l�rl Ivi�l.- . � � <br />y ' ' .. �i � �I�. 1 � <br />�]• N <br />CONTR. LICENSE M '` .. F' .',. _ .1.` ' . ". _ • <br />�� � <br />USE OF BUILDtNG <br />�,��1; i,-,�� i� <br />i �InY. <br />WORK DESCRIP110N <br />I ,�,i, <br />ti � <br />NO. I TYPE OF fIX7URE Ofl IIEM <br />Toilol <br />- �athlub <br />`�'r_ LavelOry �wash ba!tin) <br />y Showor <br />� Kilchan sink 8 dispus:il <br />, Dishwasher <br />Golhes washei <br />d Wat�r heater <br />Sink (svrvice/barimuproh:.l <br />' Backliow pieveidur <br />Urinnl <br />Drinking Fmintain <br />Floor dram <br />Grease Irap <br />Hoof drains <br />Other <br />. .. , �., i �, <br />HEAT SOURCE I CONTRACT PRICE Of� WORK <br />Eloclnr, Gas O�har <br />NO. I TVPE OF FlXTURE OR REM <br />A/C - air handlirg unils <br />i Forcad air syslems <br />__ _ Gas piping <br />' W �Inr heeler <br />� Ga:.- ��replece <br />Gasiango <br />_ :_ Clolhos dryei <br />Ranga hood <br />Exhaus� lan <br />'r Hoal pump <br />Unil heater <br />__ Boiler <br />___. Rolripara6on <br />Woodslova <br />_ Other-------- <br />CITY OF EVERETT LOCAL BALES TAIf ('AUE IS 31U5 <br />! I here�y ceritily ihat I bove read and ezaminod Ihis applicatwn and Waw �he sama to be irue and corred. All provisions of laws end <br />� ordinaces govoming ihis t}ry�e of work will be r.omplied with whelher specllied herein oi noL The grunting ol a pormit does nol pesume <br />' lo give eutfwrity lu violsle ur cancel lho provision of any olhor state� or local law regulatlng r.onsWction or Ihe performane�e ol <br />� conslruclion. That I em aulhorized by Ihe owner ol this pro� r�rty lo pc�rlorm the work lor which application is made and I comply with the <br />� SIa1e CoNradors Law 18.27 RCW and 296.200 WAC. <br />I � <br />i l, <br />i Synalure o ed ontraclor/ ul onz genl � et� e \ <br />� �'� � <br />