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SITE ADDRESS <br />� I L l �L<\1 � <br />LEGA LOT NO. <br />PERMIT APPLICATI�N <br />CITY QF 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 8 AM TO 4 PM <br />BLOCK <br />PARCEL TAX I.D. # <br />"E 25'C4��`�CI� �c.-) 7� <br />7AACT OR SUBOIVISION 7f <br />PERMIT * <br />� �a�'// <br />TENANTNAME CONTACTFORPEpMIT PHONE ��,p '�,71 ' �.�.`-13 <br />/�' I �� I E-MAIL ��y �1 -�.i I r�'C :'�l.]' <br />�:�N RA R—rhC J��%l�� 1-�-'_�1� ll�C RE N <br />?C-��� L:. �s� %•.cV;r�.� f'�� q. i1�:�,jIY� �v� �Go �4:71 - I��f, <br />CONTR. LICENSE # <br />`�Iht:;"I���r-a,��>>nr�1 � r5���. <br />USE OF BUILDING <br />NEATSOURCE <br />_ Electric _ Gas _ Other <br />WORKDESCRIPTION '��- mo�_c�- l <_ �C O�C` �� j �1���_j c <br />�Il'�iC�cl'�C.c_�lC-r,� CC 1k��.���. �.�:�j��1j <br />N0. I TYPE OP FlXTURE OR ITEM <br />Taiiet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service�badmop/etc.) <br />BacMlow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />CONTRACT PRICE OF WORK <br />�� <br />�- �\C� <br />NO. � TYPE OF FlXTURE Ofl ITGd9 <br />A/G — air hantlling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas lireplace <br />Gas range <br />Clothes dryer <br />Rangehood <br />Exhaustlan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritity thal I have read and examined this application and know the same to be true and correct. All provisions of iaws and <br />ordinaces goveming this type ol work will be complied with whelher specified herein or not. The granting of a permit dces not presume <br />ro give authority lo violate or cancel the provision ol any other state or lopl law regulating construction or the pedormance of <br />construction. Tha[ I am authorized by the owner of this property to pertortn the work tor which application is made and I comply with the <br />State ont actors �.p�y 1827 RCW and 296.200 WAC. <br />_� <br />Date � <br />l� <br />