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SITE ADDRESS <br />2�1 "l <br />LE LOT N� <br />����' � > — C� O`� <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-881r1- FAX 425-257-8857 - www.everetMra.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />Y��-'CN���� 1��b <br />BLOCK <br />CP(o(o <br />�,�� �, �-i�t,1,�� 42 <br />TENANTNAYE I <br />1��U.�� �';bc�}i l-{�W i ��M <br />CONTRACTOR <br />CONTR UCENSE f �� ' � <br />�IlU� � <br />USE OF BUILDING <br />1�4vJ c�r �� � <br />PARCEL TAX I.D. d <br />OLYoOIo(ola(�ao I CXj <br />TRACT <br />`TVNN� L <br />�7-O 7 <br />tMIT t <br />7/c)-� 2 <br />Mt�.�o�t �c�, t�. �,FY:jitu,C ��-��i- I�`f� I <br />CONTACT FOR VERMIT <br />1�Y �14tJ`'�aN <br />ADDRESS <br />, <br />HEATSOURCE <br />X Ekdrlc _ Gaa _ O�her <br />2�j2 2 t'�✓3 <br />CRY21P PHONE <br />CONTRACT PRN:E OF WORK <br />`(� 2�, o00 , a0 <br />wVRK DESCRIPTION <br />��E>L.�,T�o�� �= �o��-. c'�-�i`.� ='�-�`a '. �'r�� �,��ooN1 . <br />NO. I TYPE OF flXTURE OR ITEM <br />� � iabt <br />_ Bathtub <br />� Lrvatory (wash basin) <br />Shower <br />_ KltcAm sink E disposal <br />_ Dishwasher <br />_ CloMes washer <br />Laundry hay <br />_ Sink (service/baNmop/etc.) <br />6adclbrv prevenler <br />Urinal <br />DriNcin9 Fountain <br />_ Floor drain <br />Greau Uap <br />Root drains <br />` an�� <br />� <br />TYPE OF FDITUItE OR f1EM <br />nti — �r IuiW�inp unRs <br />Faced air systems <br />� P�P��D <br />Water heater <br />Gas 6repl�ce <br />Gas rarqe <br />CIWMes dryer <br />Ruqe hood <br />Exhausl hn <br />Hetl pump <br />Unil heater <br />Boder <br />Rehiperation <br />Woodstove <br />ane� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS �105 <br />I hereby ceritify thal I have read and examined this applicalion and know �fK same to be tnx and corred. All provisio�s d laws and <br />ordinaces goveming this type ol worlc will be complicd with whether apecified herein or not, The yranting ol e pertn% doec nol prewme <br />to give autlwriry to violat@ or cancel thc provision of any olher state or local Ww regulatirp �qnstrucibo or the peAormance u} <br />construdion. That I am ai�thorized by the owner ot lNis property to peAorm tAe work lor which app�ication is made and 1 comply with the <br />State Conl�aqofs Law 18:27 RCW and 296.200 WAC. <br />i.. �' � <br />- .�� ��. , <br />;� �� ✓ �,� � <br />��Z <br />