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Ci'//-% �,(.� <br />SITE AODRESS <br />� <br />LEGA LOT N0. <br />DESC. <br />J� �c'- [1- <br />ENANT NAME <br />'OiYlihu»�ty <br />CONTR. LICENSE # <br />PERIiIIIT APPLICA;TION <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 />TIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /># <br />�i-I,��-I «���/�%-<;���%�� <br />BLOCK TRACT OR SUBDIVISION # <br />/D - �/ -/ [� <br />JZMIT # <br />�l%���7 <br />AOURESS �IIYIZIP PHONE <br />%ticllr'd � ib-}- <br />ONTACT FOR PE IT , PIiONE r C <br />Trc�t���f I�De.13r�.o��, �io�ec�t h�Jr. � -``3 E"�IJJ <br />F.MAIL II1�. VIGv1��-�.lC�llfii' <br />— i n mui��ov� ---- <br />1N,1 kk pioti,clt(� <br />[�eit�rr�isit cf iAl� <br />USE OF BUILDING �+� � HEA'f SOURCE <br />�lS - S1�i � {+ �SI-D � �11 __ Electric _ Gas _ Olher N�R <br />WORKDESCRIPTION $���-�II �'kul �J�� �llfilD11S ��l <br />S.e.e� et-H�-c�.h�c{ �i'CZ'/. ��lw � S-��1 _ <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bolhtub <br />Lavatory (wash basin) <br />Shnwer <br />Kitchen sink 8 disposal <br />Dishv�asher <br />Clothes washer <br />Water hzater <br />_ Sink (service/bar/mop/etc.) <br />Backflo�v preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. <br />i��C�C�C(� �1115 ��c'�1 <br />� � �53 l�31 ���1� <br />CONTRAC7 PRICE OF WORK <br />�D <br />`i� �� E V2re{-�- <br />,y��.�r rev��e�� <br />NPE OF FIXTURE OR ITEM <br />NC -� air handling units <br />Forced 2ir systems <br />Gas p!ping <br />W�ler healer <br />Gas fireplace <br />Gas rang� <br />Clalhes dryer <br />Rangehood <br />Exhaustfan <br />Heatpump <br />Umt heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined this applicalion and know the s2me to be true and correct. All provisions of laws and <br />ordinances governing this lype o(work will be complied wilh whelher specified herein or not. The granting of a permit does nct presume <br />to give authority to violate or cancei the provision of any olher state or local law regulating wnstruclion or the perfortnance of <br />consiruction. Thal I am aulhorized by the owner of this property to perform lhe work for which application is made and I wmply with the <br />Stale Contractors Law�t827 RCW and 296200 WAC. <br />c <br />Z�J ' <br />'1� <br />uu� <br />O(� <br />