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11/03/Z�OB 18:26 1253615�J127 <br />i <br />hAtar, <br />PERMIT APPLICATION <br />CITY OF EVERETT PEF�MIT SERViCES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-b£310 - FAX 425-257-E3857 - www.evereriwa.ory <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADOftESS <br />�I z. N ti31�-oA4WRi <br />LEGA LOTNO. BLO-C/K <br />DESC. IS t �' <br />OWNER <br />�, uN but� <br />IENAN7NAME <br />v�,rrAt, rnaro� �Nr� <br />ks ����� <br />CONTit. LICEN3E A �/� 7� <br />USE OFBUILDING <br />�''��- <br />PARCEL TAX I.D. # <br />Z�j c;51 0 0�-o l <br />rnncr oR suoomswr+ a <br />qsz N �RU��A <br />ONTACTfORPERMIT <br />��.N�Y I� �M <br />39q �9� 3� flv S <br />�9;,�bt,�1r, 9,�c'vl <br />HEATSOURCE <br />� Electdc _ Gas _ Other <br />PHUNE <br />PAGE 03/12 <br />I 2—O Z-0 � <br />,��1� �lS <br />PERM�7S <br />20� ;�;� �ir� <br />l <br />CONTfiAGT PRICE OF WORK <br />� —yo ocx� o <br />WORK DESCRiPTION <br />6xr�o� - ��b �'Cn+rui, Hel.�,wA'`f F�iuN�t• �'`'q�,`�rops. <br />►uf"a(ua�- �cP,acs �xn��C'F�S, �qv, �[o11.sT, To�� h,��SN � vaa� IN E�1crc <br />_ ...-w.�wu�nwl <br />NO. TYPE Of FIXiURE OR ITE�1 <br />�. , Toilet <br />Balhtub <br />Lavatory (wasb basin) <br />'�� hower <br />� hen sink & disposal <br />Dis asher <br />CIOth� wn9hCf <br />� Woterhe er <br />—� Slnk (senrl ar/mop/etc.) <br />Dnckflowprev ter <br />Urinal <br />� Drinkln9 �ountaln <br />�� Floor'drain <br />Grease trap <br />Rooi dreins <br />�� Other <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C – air handling unils <br />Forced air aystems <br />Gas plping <br />Wat�r hoeter <br />Gas fireplace <br />Ges range <br />C�olhes dryer <br />ange hood <br />E austfan <br />Unit h <br />Doiler <br />CI7Y OF EVEREYT IOCAt. SALES TAX CODE IS 3105 <br />I hereby ceAlify that I liave �ead and examined tlii5 app��calion end know the same to be Uue and cortact All provisions of laws and <br />ordinaces goveming this type of work wili be complied with whether specified herein or not The g�nting oE a portnit does not presume <br />to gtve authodry to violate or cancet the provision of any other state cr local law regulatlnc� mnstrucnon ur the p2Aortnance Ot <br />conshucfion. That I am outhodzed by the ovmer of this piopedy to perform Ihe worA for which appllcation is made and I comply wiih the <br />State Contractors Lav+ 18.27 RCW and 296. OD WAC. <br />j� l �'l/�/�-� �� / � �' � � � <br />SignaNre of OwnerlContractadAuthorized Agent ate i/ <br />`- /Z <br />c� <br />