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SITE ADDRESS <br />qG b SE <br />LEGA LOT NO. <br />PFGu� <br />� <br />PERMIT APPLICATI�N <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 />� <br />BLOCK <br />�(z �V � K��" <br />�6�1/�(1 Sys%2'JI/1 S <br />S Olfrl 7�� <br />USE OF BUILDING <br />� 'fFWt✓ <br />WORK DESCRIPTION <br />6Al izXrSnNb- <br />PARCEL TAX I.D. # <br />�f'rb5/ flDO'���SD D <br />OR SUBDIVISION k <br />r yj /N F�r r�[-G (00, <br />CONTACT FOR PERMIT <br />�5'ACA ]�p�lS <br />� I FE'o� br /�0 <br />5u,.FC /� <br />/ <br />a-o <br />i u�vioN Si �S30o s��r��- s� <br />PHONE l�ZS-77a -a 33 � <br />�...0 ;oc5(Ck.�/VIJ'�', <br />N <br />/�GIF/G , N//i' <br />St53-`l3/- <br />HEAT SOURCE ONTRACT PRICE OF WORK <br />_ ��Q �/0� 0 D U � <br />Electric _ Gas _ Other <br />L/fGC-" � X�snNG- po�v,Eic' C,46ii <br />RoU�� <br />� �i f ��iu ! % � � ' <br />NO. � TYPE OF FIXTURE OR ITEM <br />Tailet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (servicelbar/mopletc.) <br />Backflow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Greasetrap <br />Roof drains <br />Other <br />I hereby certify that I have <br />ordinances gaveming ihis <br />to give authority ta violate <br />conslruction. That I au <br />Stale Contractors"Law <br />_ i" i� � <br />N0. <br />� X/S?inJ(r /�/�%L-iL�/ C/9� <br />TYPE OF FURURE OR ITEM <br />A/C — air handling unils <br />Forcad air systems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Rofrigeration <br />Woodstov on <br />Other D L/�- �/ � �� <br />N (.`` � <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br />i examined this applicaGon and know the same to be true and cortecl. All provisions of laws and <br />work will ba complied wilh whether specified herein or not. Tho grentlng of a pertnit does not presume <br />el lhe provision of any olher slale or local law regulaling construli�caGon shmade a dal comply wilh the <br />f by the owner of this property to perfortn 4ie work for which ap� <br />V and 296200 WAC. i , <br />r� <br />�2 <br />