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SITE ADDRESS <br />t s� <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />TENANTNpME <br />rH� v�T <br />R LAKf <br />CONTR. LICENSE N L ^ <br />r <br />USE OF BUILDING <br />(�C�A1� <br />PERMIT A�PLICATI�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 �� d jj%` � <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br />PARCEL TAX I.D. # <br />BLOCK I TRACT OR SUBDIVISION R <br />)E (CONTACTFORPERMR PHONE <br />�A��D I�R30�J e�a� <br />L� ADDRE 13'.i0if NE 12y"' IP <br />µ�CN K1RK�twD WA �teO3y <br />��i��� 1_� ���� <br />HEATSOURCE <br />_ Eleclric � Gas _ Olher <br />WORK DESCRIPTION U N DtR G-RD� N� �� OP OU \ OF <br />W��-1 R MpP51uK la►J� A DR���1►JG Fp��'rA1�1 <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />W ater healer <br />Sink (service/bar/mop/etc.) <br />8ackflow prevenler <br />Urinal <br />Orinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />PERMIT A� <br />�-1Z5-8 2'1-� 2 62 <br />CONTRACT PRICE OF WORK <br />��OOGO <br />�t" 6J 0 1� AT N ROO <br />N0. I TYPE Of FIXTURE OR REM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Gas fireplacc <br />Gas range <br />Clo�hes dryer <br />Range hood <br />Exhaust fan <br />Healpump <br />Unit heater <br />Boiler <br />Refrigerelion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 1105 <br />I hereby certify lhal I have read and examined �his applicalion and know lhe same to be true and correct. All provisions of laws and <br />ordinances governing lhis type of work will be complied wi�h whether specified herein or nol. The grenting ot a permil does nol presume <br />to give authority lo violate or cancel the provision of any other state or local law regulating construction or the performance of <br />con tion. Thal I am authorized by the owner of this property to perTorm the work for which application is made and I comply with the <br />S� te C Iracle,rs �aW,1�7J�CW and 296.200 WAC. <br />