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SI'� E ADDRESS <br />'.�oi9 t�� <br />LEGAL LOT NO. <br />TENANTNAME <br />! <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-fl857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />LUcr�n962�i ,D�b3 �C LQ� <br />BLOCK TRACT OR SUBDIVISION N /� <br />��� l� O J v/"� L i. G� <br />VILL�JZC <br />S ���� �s <br />GUIV I KAG 1 V I( <br />CUrJ�RrT£- `�,pCt�Fr.i�rs,�NC, <br />CONTR. LIGENSE # <br />USE OF BUILD�NG <br />I?,�s���e <br />f� <br />►07 <br />30�� B�Q� �� � <br />CONTACT FOR PERMIT <br />, � oNrJ I�r N� <br />��� �(v5 Cyn�Ux <br />Z <br />HEAT SOURCE <br />� Eloctdc _ Gas _ Other <br />r o -�b-o� <br />PERMI N(%/J Q � <br />_ / /�"/ <br />� �� <br />PHDNE <br />at„- �2s���is, <br />PHONE �-�2 S 353 �/517 <br />e.-naaL L-L�az<.i r� aE(+tc �,�. <br />?N��� �Iz5-��g- 5� <br />CONTRACT PRICE OF WORK <br />� 25 ��_ <br />WORK DESCRIPTION <br />���i����tic= C��=1Qr1�,C Sc,-►B�N� co�un,,,s, �/15Tqu. P�„P��� <br />,\luNli �o�h��)�`1-7tv� �,nc.� Ur���� SJ(��'o�T lv�G„�ns,JiacK <br />i�!-_�.-.s"5�:.� �-��l�l�,i- LtVP�. �Pn�Silill CQiG�nns /ntll,9r'�1l�� SL�_ <br />N0. I TVPE OF FIXI�URE OF ITEM <br />loilel <br />E athtub <br />Lavalory (Hash basin) <br />£hower <br />N ilchen sin4. 8 dlsposal <br />['IS�IWBS�1Cf <br />CJothes washer <br />Wator hoater <br />bink. (serviceNar/mop/cic.) <br />Fackflow prevenler <br />Urinal <br />Urinking FouMain <br />f loar dr.3in <br />Groaso trap <br />12ou1 drains <br />Ulher <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling unils <br />Forced air syslems <br />Gas piping <br />Wator heater <br />Gas lireplace <br />Gas range <br />Cbthes dryer <br />Range hood <br />Exhaustlan <br />Heat pump <br />Unit heater <br />Boiler <br />Relrigeralion <br />Waodslove <br />CITY OF EVERETT LOCAL SALES TA% COOE IS 7705 <br />N�A <br />I hereby c�ritify Ihal I have rcad and examined lhis application and know Ihe samo to be true and correct. All provisions of laws and <br />ordinaces yoveminy Ihis type o( work will be compli�d with whelher speciliod herein or noL The granti�g of a permit does not presume <br />to give authority lo violalu or cancel tho provision of any olher state or local law regulating construction or the pedormance of <br />conslru :li��n. Thal I am aulhorized Uy the ownor o( ihis propeAy lo perlorm lhe work for which application is made and 1 comply wilh the <br />Slalo Curtractorstaw 18,27 RCW and 296.200 WAC. <br />�=- ' �-- <br />• �< c � 9-ZR -u� <br />iyn�tUra of , nor! onlractodAulhorized Agent Dale �/� <br />/ 1 <br />