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SITE ADDRESS <br />_ �5� <br />LEGA LOT N0. <br />DESC. <br />OWNER <br />A-) eks�,"�< <br />TENANT NAME <br />�(�I�e.k.su,�� <br />�V V A � `n,.nJy✓1 C/� <br />CONTR. LICENSE # <br />USE OF BUILDING <br />.. <br />P��tMIT APPLICATIO": J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STRE�T, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM S AM TO 4 PM <br />BLOCK <br />S�AlGI,E. i9 M/L Y /lEliof.l�cE <br />VOR��� CRI`SP`T�ION r� <br />1- <br />PARCEL TAX I.D. # <br />lovo <br />TRACT OR SUBUIVISION N <br />��� - GD7-c� <br />6acS <br />�t'(�N 1� <br />NO. I TYPE OF FIXTURE OR ITEM <br />ToiletV ���� <br />Bathtub'� �I <br />Lavalory (wash basin) �11'r �. <br />Shower�/ 3 � � I <br />Kitchen sink 8 disposal I <br />Dishwasher <br />Clothes washer <br />Sink (servicelbar/mop/etc.) i <br />Backflow prevenler <br />Urinal <br />Drinking Fouctain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />CONTACT FOR PERMIT <br />� VIILur <br />� "S s �� <br />HEATSOURCE <br />_ Eleciric � Gas _ Other <br />n � ho�se <br />PERMIT <br />oG1 661-a�/� <br />3� - Voo'L <br />42s', 3�� �i� <br />CONTRACT PRICE OF WORK <br />2, <br />N0. I TYFE OF FIXTURE OR ITEM <br />AIC - air handling unils <br />�Forced air systems i <br />Gas piping �jY( I <br />� Walerhealer� <br />�, Gas fireplace } <br />�, Gasrange <br />�, Clothes dryer <br />�Range hood <br />Exhaust fan f,�" I � <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVFRETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify thal I have read and ex�mined this applicalion and know the same to be true and correcl. All provisions of laws and <br />ordinances governing this type of work will be complied with whelher specified herein or not. The granting of a permit does not presume <br />to give authorily to violate or cancel the provision of any other state or local law regulating construction or the performance o( <br />consiruction. That I am authorized by the owner of this propeAy lo perform the work for which application is made and I comply with lhe <br />State Conir tor 27 RCW and 296.200 WAC. � Q �3 �� <br />SignaWre of wne n ractor/� rize� � ate � <br />lz <br />