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�' <br />_� <br />PERMIl' APPLICATION <br />CITY G`F EVERETT PERMIT SERVICES <br />3'L00 GEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-885/ —www.everett�va.org <br />APPLICATIONS ARE ACCCPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS �NA �?S�}4� PARCEL TAX I.D. # <br />-� o0 5 i o <br />�1 z�-=� A vt. �t � n ��a - <br />LEGA LOTN . ,BLOCK�,�.� TRACTOflSUBDIVISIONp <br />DESC. �rt 7- �<:, � l�ut, _� Yn �- l 1� i'„ � "J � i �li-i U�t/a f�,� �� � <br />v-a . i_�I I�fc�'," � C i�1 � l f If� ✓�i,: _ <br />OWNER �_ � ��. AUDRESS � CITY2IP <br />�i��zr �� ��,r I-4n,u ti;; �I i,;, � i �ulrLt�;A <br />(: A� �� I 1�L I�iJ <br />FOR PERMIT <br />c���i1`� ��S1��GIZIZ <br />a �a6--�� <br />PERMIT # <br />�z;� 02. o�l <br />PHONE`'-�,�-5% ti 7"�- h <br />'�i <br />CONTRAC70R /� N��^��� "" ""` ' � ` <br />�j1���9+,lll�c✓ l,C1L'>1l U,L�iiS�L � C� �L� �->(,(�� ���i:l��-VC:a.� _�Lj ji ��57-�- <br />CONTR. LICENSE p�- � � I� A <br />U I-Y M i'( i�_ I'-�L, (�[ > �--- <br />USE OF BUILDING <br />WORK DESCRIPTION <br />HEATSOURCE <br />_ Electric _ Gas _ Other <br />,- ��, ,. ��_ n,,.��,-G �'i n1 .; ,ti� <br />i <br />N4. I TYPE OF FI%TURE OR ITEM <br />Toilet <br />Bathtub <br />Lava';ory (wash basin) <br />Shower <br />Kitchen ,Ink 8 disposal <br />Dishwaslier <br />Clolhes washer <br />Water healer <br />Sink (servicelbzr/mop/etc J <br />�ackllow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roo( drains <br />Other __ <br />CONTRAC? PRICE OF lYORK <br />`��%.j,ODU nu <br />F� �eti'l-ui Qt=t'ict <br />NO. I TYPE OF FIXI'URE OR ITEM <br />A/C - air handling units <br />Forced air syslems <br />Gas piping <br />V2ater heater <br />Gas limplace <br />Gas rangc <br />Cbthes dryer <br />Range hood <br />Exhaustian <br />Heat pump <br />Unit healr.r <br />8oiler <br />Relrigeralion <br />Woods�ove <br />Other <br />�m�. . G _ �.��✓ <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />I hereby ceritify that I have read arid examined this application and krow the same to be Irue and correct. Ail provisions ol laws and <br />o�dinaces govaming Ihis type ol work will be compl'ed with whether specified herein or noi. The granting o( a permit does not pmsume <br />to give authoriry to violate or cancef the provision oi any other sfate or local law reg�i�ating construction or the pedormance ol <br />consiruction. That I am authorized by the owner of this property to pedorm the work ior which application is made and ! comply with the <br />State C mractors Law 1827 RCW and 296.200 WAC. <br />� � /� 2-I(-Oy <br />Signature ot Own�'actodAuthoriz�tl Ngr,�nt Dale �/ <br />2 <br />1'v? <br />