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SITE ADDRESS <br />1 zl Sr_- �V��C n <br />LEGAL LOT NO. <br />DESC. � � L }�� � IC�FT <br />TENANTNAME <br />S;��M � ��- ,�'��f-A <br />CONTR. LICENSE # <br />�EkMIT APPLICATIVN <br />CITY OF 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 />r��;�i� c^J- <br />BLOCK <br />� I.L li' � C) <br />Sl! c��, <br />USE OF BUILDING } � �' ' <br />c„�,��ec�R-ti;m,� <br />�� ;.•�. ^�! z: �L' /P� <br />�+`flPARCEL TAX I.D. # <br />Ob�{.SC,�OI �p /:z00 <br />TRACT OR SUBDIVISION p <br />5 %�1 Pu,vJ Nr�'< < <br />I CONTACT FOR PERMIT <br />t �i R- (� /1 <br />HEATSOURCE <br />X Eleclric _ Gas _ Olher <br />WORK DESCRIPTION .�y� <br />lJ..j� �^r(.S� E�-k�si �C� /IJ`��-1(7P.� !/�riL.(,j /—�"� �Lf�`✓� <br />(,�;.tJ�i�iE'.�GT lJ5(/l ^nk'N /�'l'P;7 STG�,i7 l��ll6 1-'i�L %��%'�+�1 <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilcl <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sinA 8 disposal <br />Dishwasher <br />Clothes washer <br />Walcn c�aler <br />Sink (service/barlmop/etc.) <br />Back(low prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roo( drains <br />Olher <br />�1�6-0� <br />PERMIT # <br />� <br />,� 09//-00� <br />o�it��l �� �y0 y-� .s�f � <br />PHONE �lxS'�� � ��S J <br />� <br />E-MAIL ✓'RUS(rL1 6T I��'?r) <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC — air handling unils <br />Fnrced air systems <br />Gas piping <br />Water healer <br />Gas (ireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaust fan <br />Hcat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify that I have read and examined this application and kncw lhe same to be Irue and correcL All provisions of laws and <br />ordinaces governing lhis lype ot work will be complied with whether specified herein or nol The granling of a permil does not presume <br />lo give aulhority lo piolate or cancel the provision o( any olher stale or local law regulating conslruction or the performance of <br />conslruclion. Thal l am aulhorized by the owner o( lhis property to pedorm the work for which application is made and I comply wilh lhe <br />Stale Contrsctors Law 1��?7�CW and 2 200��C. <br />�, � / �? %/' �' " �UD�� <br />`�� �i �%��'"/� � p�i! L <br />Signaturo ot O�p(hedContr`aclor/A h�r¢ed�nt Date `I <br />Z <br />