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SITE ADDRESS <br />90� S� . <br />LEGA LOT NO. <br />DESC. <br />NAME <br />.> <br />� <br />y <br />PERMI� APPLICATION <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 />APPLICRTIONS ARE ACCEPTED FROM 8 AM TO 4 PM g a 6��D <br />BLOCK <br />Ne�,f�n� an� G.�o�, J <br />CONTR.LICENSE# CF�WH�NC�I�O� <br />USE OF BUILDING <br />G o/�'� /T�1, etC � 4/ <br />WORK DESCRIPTION <br />�'el�c«f� <br />ce <br />PARCEL TAX I.D. # <br />x <br />TRACT OR SUBDIVISION # <br />ADURESS <br />�f;��� <br />ICONTACT FOR PERMIT <br />�i , e�� <br />?�o. �z 37�5 <br />HEATSOURCE <br />PERMIT # <br />Y���o��- G51 <br />CITYIZIP PHONE <br />PHONEz� �3c��-1 i �� <br />K,YkJv�l, u.a.9E��� <br />Eleclric Gas Other <br />�eis . <br />ex�af%�-� c : � <br />NO. TYPE OF FIXTURE OR I'.EM <br />Tailet <br />Rathtub <br />_ La�tory (wash basin) <br />Kitchen s & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/barlmop/e <br />BackAow preventer <br />Urinal � <br />Drinking Founta' <br />Floor drain <br />Grease p <br />yzs'y21 •lZS3 <br />CONTRACT PRICE OF WORK <br />�3,/c�d-�� <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — 3ir handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />_ Gas range <br />Clothes dryer <br />Range hood <br />Exhaust (an <br />Healpump <br />Unit heater <br />_ Boiler <br />Refrigeration <br />Woadstove .�1il5�,�S <br />,,,� Other C � u . -�e � <br />CI7V OP EVERETT LOCAL SALES 7AX CODE IS 9105 <br />I hereby certify that I have read and examined this application and know the same to be lrue and corcect. All provisions nf laws and <br />ordinances governing this lype of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authonty lo violate or cancel the provision of any other state or Iocal law regulating construction or the pertonnance of <br />construction. That I am authorized by the owner of this prope�ty to perform the work for which application is made and i comply with the <br />State Coptryctors Law'8.27 ROiN and296200 WAC. <br />