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SITE A�DRESS <br />� ' , <br />IbGA! LOYNO. <br />UFSQ i � <br />P'ERMIT APPLICATIOfV <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAFi STREET, CVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. R <br />, , ,, ( <br />BLOCK TRACT OH SU9DIVISION f <br />� 1 � . , � , �f <br />:1 . ��...i . '_i�i <' � <br />-� � a--o -� �i' <br />ERMIT p <br />��li ;' �1- c:c, R <br />' ��! (�(��L� <br />.1 �. . i��' �.� �.,.r�t��}`1��� l�i'�.(11i24�. <br />' ,r�. .,�'. i_li� ' ��: I'A, �.�i. . . � <br />TENANT NAME I CONTACT FOR PERMIT PHONE ��. �;.�": -;� i� � t '�'<' <br />I.. . � � � i , EMAIL • � � ' r '� r � ' ' . <br />Z`ZSFPi6 � � t ... . r' i � � , � . <br />. . . . 1 i � i t . , , _ <br />�' 1..�. LI � . <br />CONTR. LICEN3E / , <br />� r �';l'����r����... , <br />USE OF BUILDING <br />�• �JI.� i � �,�, 1 � <br />i ltr,r, <br />WOflK DESCRIPTION <br />� ,��. 'I��I+ <br /><��i��rli(tl (, .�,• <br />1 <br />NO. I IYPE OF Fl%TURE Ofl ITEM <br />Toilo� <br />'�� Bath�ub <br />.•�� Lavatory �wash basm) <br />� Sl��vror <br />Kilr.hen sink & disposal <br />Dishwashar <br />�� Clothes washei <br />f Wator ht�ater <br />� Sink (service/bar/moµ'r+lc.l <br />� � F3ackllow urevenler <br />Urinal <br />Drinking Founlain <br />Fl�ar dram <br />� Greasa Irap <br />Roo1 drains <br />Olher <br />i.^ . , , j, , . <br />-- HEAT SOURCE I CON'IFACT PRICE OF WORK <br />Elcclnc Gas ___ Othcr <br />NU. I TVPE OF Fl%TURE O:i ITEM <br />AiC - art hardlmd units <br />�_ `orcal aii syslems <br />Gas piping <br />( Watar healer <br />Gaslueplaco <br />Gas range <br />. ; Clothes dryor <br />1._ Range hood <br />� 6xhaustlan <br />Heal pump <br />Unil hoaler <br />�oiler <br />___ Relri�em6on <br />Woodstove <br />— - O�her - <br />CITY OF EVcfiETT LOCAL SALES TA% CODE IS 3105 <br />I hereby cerility that I have read arM exammed Ihis upp6cation and kiww ihe same to be true encJ correcL All provisions of laws and <br />ardinaces povorning Ihis type ol work will be complied wilh whether specilied herein or not The grnnUng ol a pormd does nol presume <br />lu give aulhniity lo violale or cancW !ha provision of any other sinte or local law regula(ing sonslruc6on or ihe perlormance ul <br />consUur,tion. Thal I em eulhurizod by Iho owrrer o� ihis properly to perform ihe Hork lor which epplicafion is made ard I comply with Ihe <br />5�nte (�nL-ectors Law 78.27 RCW nnd 296.2W WAC. <br />� <br />�/� I� <br />. _ . . . .._-----' <br />