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1 <br />�� �� 7 <br />SITE ADDRESS� <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />�c��l�s <br />TENANT NAME <br />• <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />�C�%��S�,S �A-P'PLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />� PARCEL TAX I.D. # <br />�� D 3 2 Z C�<��J<�� <br />BLOCK TRACT OR SUBDIVISION # <br />' �a � 80'� �s. f�. s� <br />CONTACT FOR PERMIT <br />� ►� � �I�l <br />�./��;�2�2�►tii <br />� <br />PE IT # <br />i�>�» - <br />PHONECj�,�zcJJ �?,S3_7 <br />PHONE t 3l00) '� ay- � �yg <br />I��VII l[C5 , V �tl �n� � US �a. u � E-MAIL,}OSIIG�X��IYY1(� LI/Y <br />CONTRA T � X, ��il-� lYY l�S� !' A��R 1"�% ��G o1-�GI y 7 �Y�iQ`U%l� l/ P/liiG�'7 C 3(Y�J� <br />CONTR. LICENSE # ��a,�3 yaU-6�S <br />Ax e Lz, c� i� D U <br />USE OF BUILDING HEAT SOURCE ��� CONTRACT PRICE OF W�ORK <br />j i/1�f1,(,L�Z!�,L�rc,/L� _ Electric _ Gas _ Other � 3��j� Q(�(�.� <br />WORK DESCRIPTION — <br />�s��� � o -F � � �c�C� �r`y 3 �� 3 !�� i o �sw��8'Z5 � s h <br />►'�`�'"'u--`�-�-r"� � �vCCc�-FtCi R�" � <br />�`►•�rLo l� � �J � S CP/� 1�� -��z � <br />NO. I TYPE OF FIXTURE OR ITEM <br />�i <br />� <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />hower � <br />chen sink & d osal <br />Dis washer <br />Clot s sher <br />Wate eater <br />Si (se ice/bar/mop/e�.) <br />Urinal \ <br />Drinking Foi <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air h ndling units <br />Forced�ystems <br />Gas oi na <br />Wat heater <br />G fireplace <br />as range <br />lothes dryer <br />nge hood <br />Exh ust fan <br />Heat mp <br />Unit he r <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />.',���G�� r �`/� <br />�ij �'� - �,�(� <br />�� �% %�/ <br />I hereby certify that I have read and examined this application and know the same to be true and corret. All provisions of laws and <br />ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not prasne <br />to give authority to violate or cancel the provision of any other state or local law reglating construction or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I coml� with the <br />State C actors Law 1 27 RCW and 296.200 WAC. <br />�,uQ_ ��%�w, `� 1�, � J n <br />ignature of�Owner/Contractor/Authorized ,�gen <br />c-sf�L <br />r�eT <br />��3 <br />