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�. �� pERMIT API'LICAT'ON <br />CIl Y OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-881 U— FAX 425-257-8857 — www.everettwa.org Q_l /! � <br />� r� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM /�///1/)�_/1 � <br />i (/� (/ <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT d <br />/,� SGu L�Ve�e�i(it� L�veF�� yZGaG/ GC� t> lOdB- [.'YJ <br />LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION p <br />DESC. <br />rVC'Y�Ki 172UJ[-GT LLG .2a�, 3s � P� � ��rrrcE'�'iiz Z�_ 3az- 36 <br />iENANTNAME I CONTACTF(1RPERMIT PHONEZ53'ZC�b'� 2�,73 <br />/d l�-C�crc�_ �ea-G�/1 �/�. ; �SYaeC �eV'Pz,- I aaa.GtuS�-c 2 p <br />— . _ E-MAILZ�J J�(J �1�0 �I ZI�o <br />s����c,r� H��.�Sysk���5 <br />CONTR, LICENSE # <br />��ir � n � �s/3� oT <br />USE OF BUILDING <br />��c <br />„�„n�„��o�-syr�� � <br />HEATSOURCE <br />_ [lechic _ Gas _ Other <br />WORK DESCRIPTION <br />%NSTAL[�N.4Ti NE+� ��G✓/��"T ='P�'"'�/LGE.�S <br />NO. I TYPE OF FIXTUR[ OR ITEM <br />Toilel <br />6alhlub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />__ Sink (service/badmop/elc.) <br />CiackOow prevenler <br />Urinal <br />Drinking Pounlam <br />Floor drain <br />Grease trap <br />Rool drain� <br />.SZ Olher /�LE e�y.�Ef25 <br />i %a�Um�� Gv.�? 9�1a[� <br />L53-y2�-is8o <br />CONTRACT PRICE OF WORK <br />� f,83�- <br />TU �C�[,.�+oo¢-/� i"z'6 NE+✓ L'Eiu.vti � l✓AGlJ <br />MECHANICAL <br />NO. I NPE OF fIXTURE OR ITEh1 <br />NC - air handling units <br />Forced air systems <br />Gas pipmg <br />Water healer <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />[xhausl fan <br />Fleal pump <br />Unil healer <br />Boiler <br />_ Re(rigeralion <br />Woodstove <br />Other <br />CITY OF [VERETT LOCAL SALES TAA CODE IS 7105 <br />I hereby cer�ify Ihal I have read and examined Ihis apphcalion and kno�v the same lo be Irue and correcl. All provisions of la�vs and <br />oidinances governmg Ihis lype ol woik wtll be comphed wdh whether speci(ed heiein or not The granting ol a permit does nol presunie <br />lo give aulhonty Io violale or cancel Ihe piowswn of any olher state or lucal law regulaGng conslruclion or Ihe peAonnance of <br />construction That I am authorized by Ihe owner of Ihis pioperly lu perform ihe work (or v+hich application is made and I comply vnlh Ihe <br />�Stale C nlractors Law 18 2' RC1N anJ 2962001NAC <br />� r� �� 9�3 -�t) <br />� nRhu � nl (7wnndCnnlrarindAidhniionrl .lnunt n.,�� <br />��� <br />