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SITE ADDRESS <br />� �t_ <br />LEGAL LOT NO. <br />P�RMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERET'i , WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM /��� - <br />�:.;��-�.�t Ct���\� <br />BLOCK <br />TRACT <br />PARCEL TAX I.D. # <br />PERMIT # <br />S-t �;r�o't---�� '�.;�r�� �U,.L. �'�-\'� Jo,�K�ac n�.-�,� ���i) \����Qo��l _ <br />TENAMi NAME CONTACT FOR PERMIT PHONE <br />�Y�� m[�f0. Aif� �Lfitd�.��t� <br />CONTRACTOR , <br />cne_i��o ��c:�,.,�, <br />CONTR. LICENSE il � __ <br />USE OF BUILDING <br />�� <br />ADDRESS <br />\\Gy.A 1���''-'j7�_1�,��, I�,����G�;� <br />G s�i''�� � � ,2C. �'L/? IG7 <br />x€nTsouRce <br />Electric V Gas Other <br />CITY2IP <br />� =� °�� U3 <br />PHONE <br />�_��a_c11c��, <br />✓'/111�� � <br />_ ) <br />��R �E \\ IPT1 N \) rn�.�, , 1 <�re!JS� ��1�?� �7:�v��\ �c,�� . <br />— �Z v ':� <br />NO, I TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ $alhtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/elc.) <br />Backflow preven(er <br />_ Urinal <br />_ Drinking Fountain <br />_ Floor drain <br />_ Grease lrap <br />_ Roof drains <br />011ler . ___ <br />PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR �?GM <br />.:L A/C-airhandlinpunils <br />_ Forced air syslems <br />Gas pipir.� <br />Waler healer <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />`�i_ Rango hood <br />_ Exhauslfan i��� <br />_ Heal pump � <br />=Unit heater j� , <br />Boiler � � <br />_ Refrigeralion � <br />__ Woodstove �V <br />Olher(h �,�1 Uv .\- <br />�.�c-• w' � ! «C J <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br />I hereby cerilify thal I have read and examined this applicalion and kaow the same to bo true and correct. All provisions of laws and <br />ordinaces governing lhis lype of work will be complied wilh whether specified herein or noL The granting o( a permil does not presume <br />to give authorily to violate or cancel the provision of any other slate or local law regulating construction or the performance of <br />r,onslruction. That I am authorized by the owner of this property to peAorm the work for which application is made and I compty with the <br />State Conlractors Law 18.27 RCW and 296.200 WAC. <br />.-` `� C� C � �� �. <br />� <br />S- �4 O� <br />,�a <br />