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SITE ADDRESS <br />LOT <br />CC�ti v.��: i c� <br />TENANTNAME <br />PERMIT /lPPLICATION <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 />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br />�yQ, PARCEL TAX I.D. # <br />P i"� = i'�%`��c��lC�3c)Co�1Ct: <br />� OCK TfaACT ��XC- �'2 T.%=P,:1� 1�. � <br />. u�ti ��c ac� w� ���s <br />ADORESS CITYIZIP <br />��� � �(�. i�Q( �1�'16�5"30 �'Yirl t111'�i,411� <br />; CONTACT FOR PERMIT <br />CONTRACTOR /��� ADDFESS �% �� �7�� ��C CIN21P <br />LI11l�_�l.'��2�J ll'1'1�jjY'UCilli�� L�� �,y� <br />CONTR.LICENSE# ����k'�r`'Y� _�V`��� S�'`I <br />. ._ ' . _'_ _'�n <br />USE OF BUILDING <br />�. <br />-�'�C'�i � <br />� `- 01� � ` (% % <br />RM I,T # <br />�/..� �n� _-2 <br />1Y�G+ <br />PHONE <br />l(i')T�' I�yrJ <br />PHONE <br />v�� �i%.'�5 (�.��' <br />-- ; IEAT SOURCE I CONTRACT PRICE Of WORK <br />��Electnc _Gas Other . '��(Q��Jl.)�. Ob <br />WORK DESCRIPTION <br />.�Yti-+-+����?�kCin:GC a--in�*�� ��-{»,.7iritiiu� ���`i� ^e�;%du.Y_'� Ctr�d�. ��itd�:Xu�� <br />:���l:rrk a- C:Str (�'l�F. �;rbtiu�� f'_� �'W'�1?v� E� i`Sr��u� l.i�r?�v�cs u;il1 �:. ��-,�Jc-4i�1 -IL <br />� c •���-i�-��rir,s� �1.z�::� ��;Ii; 1 �t��1+.n... -C'1;, • %�D-,�, <br />_..........,. � enorun�I�rn� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink & �r �-?osal <br />Dishwasher <br />Clolhes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />NO. I TVPE OF FIXTIIRE OR ITEM <br />A/C - air handlin9 units <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Ezhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SAIES TAX COOE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and corred. All provisions of laws and <br />ordinaces goveming this type of work will be complied wilh whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision oF any other slale or lowl law regulating construciion or the perfortnance of <br />construclion. That I am authorized by lhe owner of this property to perTorm the work for which appliration is made and I comply with ihe <br />Stale Contraclors Law 1827 RCW and 296200 WAC. <br />_rJj�.,(7 <br />