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SITE ADDRESS , <br />Yo� tiE �c�r-/� <br />LEGAL LOT NO. <br />DESC. G <br />P�RMIT APPLIC�►TI(�N <br />CIT'Y OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERrTf, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICAYIONS ARE ACCEPTED FROM S AM TO 4 PM <br />PARCEL TAX I.D. # <br />���r ���� � BoSI go U 3 <br />RLOCK TRACT OR SUBDIVISION # <br />�-t7-o7 <br />�jD707-d7(7 <br />PERMIT # <br />l �1-��'�'� � Fi�i <br />Pr,�UCG�i� El�r�.� /fGG!>i,/L�G S; `f2�5'D �///Sl ��e v�l��/.� u4 �/3 9ooio <br />TENANT NAME �'Fk,/} CONTACT FOR PERMIT PHONE Zo6 -3 yy-yZ�9 <br />T�Z�OL.�/Ie CI,S� V'DiC�,s/n'u�GnC- rTbi�L-�2�t.N-S `E-n,AK � ��last .�ie� <br />C NTRACTOR ��� '�.�'2�MMlLU�4�7p�,JDORE CINIZIP PNONE <br />`� s po �o X,3 6 0 /�P ��r/e y Lvrr 9B 3 zz <br />CONTR.LICENSES ��/nG�� �OS �a �„�p. S�; l0�. %�; 2s3,GBb-azs� <br />l7l7 ��i / i (� i ' <br />USE OF BUILDING <br />���/CC <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />�Electric _ Gas _ Other � $5/ Ov � u <br />WORKDESCRIPTIOM�VS�, ��sfi� Gvj,•�e%5� '���/i,l-rt on� ,C'ooF-G�rre�4�ly <br />CG(i G�vb�t��na-S Cu'� o�� �c. p(�.��,e /e� asE �irrr� oF ��Uldii !uot� �3 <br />fc2•�4��nrcS �fII yScJ Gorn� CZ,,-� 3����n � �o S� .�ccon�yu� ��s <br />�.. _ �a,r-r — <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />BathWb <br />Lavalory (wash basin) <br />Shc .ver <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />l4�aler he�;er <br />Sink (service/bar/mop/elc.) <br />Back(low preventer <br />Urinai <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Gther <br />NO. I TYPE OF FIX"'RE OR ITEM <br />A/C — air handlin� unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas freplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unil heater <br />Boiler <br />Re(rigeration <br />Woadstove <br />Other _ <br />CITY OF EVERETT LOCAL 5ALES TAX CODE IS 9105 <br />I hereby ceritify that I have read and examined this application and know lhe same to be true and correcL All provisions o( laws and <br />ordinaces goveming lhis type of wo k will be complied with whelher specified herein or noL The granting of a permit does not presume <br />lu �ive aulh�J7ly o violate or c the provision of any other state or local law regulating construction or the pedormance of <br />consiruatio) r�. Y iat I am autl d by the wner of this prope�ry to pedorqi the work for which applicalion is made and I comply wilh lhe <br />Ste.t�E(a ors Law 1. CW an 96.200 WAC. <br />,,. �3�1� <br />Signatiu ot wi er o tiaclodAuthorized Agent Date 1 l <br />Z <br />