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SITE ADDRESS <br />r Y��._1 .S� <br />LEGAL L0T NO. <br />DESC. <br />PERIV�IT API�LlCAiION <br />CITY OF EVERETT PERMIT SERVICEa <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8$57 — wvrri.everettv✓a.orcl <br />APPLICATIONS ARE ACCFPTED FROM 8 AM TO 4 PM <br />lk: � ��. <br />�<, -, � V ��1.; f 14 %. <br />, BLOCK TRACT <br />PARCEL TAX I.D. # <br />/ <br />Gii i� � / <br />� ��.-s�SJ ; �J�i ��Jtr� j-� �":�,athll� �L< _ <br />TENANT NAME I:ONTACT FOR PERMIT PNONE <br />1 n i 1 ^� <br />J��.' ri9 �..' 3 1�+ I'C :'"1 �"`)1 4-c I�3c�µ.� 4� .3�:� -/ 7�/�' 7.3J� <br />CONTRACTOR , 1 A�DRESS , } n. CINIZIP PHONE j�o -���_ �73, <br />� 5 1-�'-..ct`�„-� ��, �) t r;� _S � a E-�-5 t--�i��R 7� ��h �s �� .`� o".� 7,� <br />CONTR. LICENSE.Y �� y 1�T:� �. _�: q 3�; n� <br />rr <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />�' ' '" <br />`��-�-�� � � � Eiectric __ Gas _ O;her �S � `� J J � <br />WnR.0 DESCRIPTION ^ <br />T.:, s('-,11 '��� c-�"c,:_� , 5 0�, ��s , r� c� <br />�"� �' `G?Ci.S Ila1 � .7T�� c�-dt � (f <br />NO. I TYPE OF FIXTURE OR ITEi.i <br />Toilet <br />Bathtub <br />Lavatcry (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service!barfmopletc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floordrain <br />Grease irap <br />Roof drains <br />Other <br />� � %'rlc/ J �SI`�-f� <br />NO. I TYPE OF FIXTURE OR ITc'.'� <br />NC - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Ciothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodsto <br />_ Other ` �5��—� <br />CITY OF EVERETT LOCAL SALEC TAX CODE IS 7105 <br />I hereby ceriti(y that I have read and examined this application and know the sa'me to be true and correct. All provisions of laws and <br />ordinaces gov=_miny Ihis type ol wurk will be complied with whether specifed herein or not. The granting of a permit does not presume <br />to give aulhority to violate or cancel the provisicn of any other state or local law regulating construction or the periormance of <br />construction. 7hat I am authorized by the owner of this preperty to perform ths work for which applicat!on is made and I comply with lhe <br />State Contractors Law 182/7 'RCbV and 296.200 WAC. <br />,� _.. 7Y�_._--y_ f%—�/-c» <br />