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PERMIT APPLICATiON <br />CITY OF EVERETT PERMIT SER�/ICES <br />3200 CEDAR STREET, EVERETT, WA 9820'i <br />425-257-8810 — f AX 425 �57-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBI7 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. p <br />79Z9 f3�v BIND, Et�a �+3 o03�T3�7B0�/Oo/QZ <br />L[GAL LOT NO. BLOCK TRACT <br />oesc AI►acN.� LLT/ 004�'0� <br />�guR L.4-,�H �1,9ftK Tn+c, <br />TENANT NAME <br />�eb �ct� /�N�u-- <br />��:�u�.�r.� � <br />CONTR. LICENSE p <br />USE OF BUILDING <br />Qes . <br />o w r��. <br />' 7� <br />PERMIT q � <br />'7 n� <br />�� i._,��i�. . �'UC.i <br />nuuntss arrinr rnone�.p6•57��']77� <br />/99�N AuRoeA►!�V#lll, Sl��a.tG,u, w.t q�°i33 <br />CONTACT FOR PERMIT PHONE <br />ga���r A��. (N�� zoa.b��.���7 <br />nooRess <br />HEAT SOURCE <br />� Eleclnc __ G�� Other <br />WORKDESCRIPTION !_ .N�q.f�D �I(�[ �0�. S'7'/�}/(tS� <br />I Pr�R-o-oM� � Re.v+nov�� k�► Coo�-1� <br />orM� ahM.o • <br />NO. I TYPE OF F1XiURE OR ITEM <br />__ Toilet <br />Balhtub <br />_ Lavatory (wash basin) <br />Shower <br />_ Kdchen sink 8 disposal <br />Dishwasher <br />_ Clothes washer <br />Laundry trey <br />__ Sink (sorvicelbadmop/etc.) <br />__ BackOow preventer <br />Urinal <br />_ Dnnking Fountain <br />Floor drain <br />Grease irap <br />. ___ Roof drains <br />Other <br />CfTY21P PMONE <br />CONTRACT PRICE OF WORK <br />'CNANG� wINDOW <br />-i�+ (���j C_srovd) <br />ao wN��+12. <br />w� P�a��n^w.�' <br />NO. I TYPE OF FI%TURE OR ITE�1 <br />NG — air hantlling unils <br />Forcad air syslems <br />Gas piping <br />Water heater <br />Gas firoplace <br />Gas range � j�yem O Vlld� Q) <br />Clothos dryer V� <br />?ango hood <br />Exhausifan <br />Heat pump <br />Unit hoaler <br />Boiler <br />Rafrigoralion <br />Woodstove <br />Olher l�e� QbltT,e <br />CIN OF EVERETT LOCAL SALES TAX CODE IS b105 <br />I hereby certify that I have read and examined lhis aFpiicalion and know the samo to be true and corroct. All provisions o( laws and <br />ord�naces governing this type ol work will be complied with whelher specified herein or not. The g�anting of a permit does nol presume <br />�o give aut to violate or cancel the provision of any olher state or local law ragulating construction or ihe peAormance of <br />c.:nslru o hat I am authorized by tho ownei of this property to pedorm lh� work for which application is made and I comply wi�h lhe <br />State o acrors w 1827 R��W,\C. _ 1�' I� <br />�� � <br />