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SITE ADDRESS <br />4�ZZ,5 �i�y i� �v <br />LEGA LOT N0. <br />DESC. Z, <br />�. <br />PERMIT APPLICATION <br />CITY OF EVERF.TT PERM6T SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-88� 0 - FAX 425-257-8£f57 - �rvvw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 aM <br />PARCEL TAX I.D. # <br />5��� f� 005822oz I Dozo� <br />BLOCK TRACT Op SU6DIVISION If <br />c5L1 a7' c-D <br />�3�-t 1�6,�- ►J��c� BI�! L� <br />TENANTNAME <br />��, �o�� ��UZro <br />c6A'fFiJG�TbA _ d �tel��� <br /><.FN F�e�.i�n� an .� <br />CONTR. UCENSE R <br />USE OF BUILDING <br />WOfiK DESCRIPTION <br />-1-r�S�c:�� �J) <br />� � <br />fe�ii,rn o��, <br />3 —6—�5 <br />rn o903-0�3 <br />PERMIT # <br />yaZs I-�y+ A�c ��. f� A,C�� ;�, 9�zQ3 <br />CONTACT FOR PERMIT <br />�0.��I �Nf�JY1Cx�'1 <br />o. Pcx $zi�n <br />HEA?SOURCE <br />^ Elechic Gas Other <br />ile�v E��u��� �an5 C1i�Cl <br />�5 -�t�� ��r.5 C�t���c�. <br />NO. I TY?E OF FIXTURE OR ITEM <br />Toilet <br />Bathlub <br />Lava�ory Iw:+sh Uasin) <br />Show�er <br />Kitchen sink & disposal <br />Dishwashcr <br />Clothes washcr <br />W ater heater <br />Sink (service/bar/mopletc.) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Fluor drair <br />Greasc trap <br />Roof dreins <br />Other _ <br />PHONE yZ5-�/p/- <br />����Z� <br />CONTRACT PRICF. OF WOflK <br />� S�cx�D.Uo <br />re.�a« all E,;rs-�;�� 70����� unc� <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />A/C — air hantlling units <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas I�replace <br />Gas range <br />Clothes drycr <br />Range hood <br />Exnaustlan <br />Heat p��mp <br />Unit heater <br />doiler <br />Refrigeralicn <br />Woodstove <br />Other <br />CITY OF EVERETT LOCA: SA! ES TAR CODE IS 9105 <br />I h�reby cerilify iha� I have read and examined this application and know tha same to be Irue and correct. All provisions of laws and <br />or�,inaces go�eming this type ol work will be complied with whelher sper!lied herein or nol The graniing ot a permii does not presume <br />to �ive auth�rity to violate or cancel the provision ol any olher state or local law regulating constmction or ihe pedormance of <br />wn,tmclion. That I am au�horized by ihe owner of lhis properry �o perform ihe work lor which application is made and I comply wi�h ihe <br />S�ate Cont actors Law 1827 RCW and 25b.200 WAC. <br />% _ �I�vi . _ ,�.. �, _,. <br />