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�#£ ADDRESS <br />�::c' t ✓�d<%, <br />LEGA LOT NO. <br />DESC. <br />OWN,Fp <br />� � q�� <br />TENANTNAME <br />i�IZ.�iZ� <br />PERNiI�' APPLICATION <br />CITY OF EVERETT PERMIT SEFiVICES <br />3200 CCDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-E857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />A�af.c co•A; � 2 <br />BLOCK <br />L So.�� <br />�, n�nn�.wn <br />� tJhl S✓Sjci�. 5 I, � <br />COtfTR. LICEt<SE # ��tt%�tlsS n � ,� � <br />USE OF BUILDING <br />I PARCELTAX I.D. # <br />�7_ SUS/�c�v3on°/or� <br />TAACT OA BUBDIVISION N <br />�L�o�i✓Es i Ld Kr.l�vl= _ <br />S C.9 :i L e u/ A `%�/�% <br />CONTACT FOfl PERMIT PHONE <br />/e�L�� ��;r <br />S � <br />2- zl- oa <br />f/r�o`� i3 i+"_P� st <br />HEATSOURCE <br />_ Elec�ric __ Gas ._ Olher <br />WORK DESCHIPTION <br />Z�s /•� L L S�Cv�c� O.� /-AcL Or t3L c� <br />ryp, I iYPE OF Fl7(TURE OR ITEM <br />Toilet <br />Bathtub <br />Lava�ory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water healer <br />Sink (service/barlmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />l 1 —I � --v� <br />PERMR # <br />5�.� f 1-oC�1° <br />nunc <br />zc c• - l8Y - s C. s�� <br />-3S3-y17 <br />MAILS � NNl1K�in.iFt_v��ccii <br />� «..:�c.�s-i, <br />��S'_ju l -fuyU7 <br />c cilEEK,��I >dliz- <br />� <br />CONTRACT PRICE OF WORK <br />� <br />NO. � TYPE OF FlXTURE OR ITEM <br />AIC - air handling units <br />Forr.ed air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heal pump <br />Unit heater <br />Boiler <br />Relrigeratian <br />Woodstove <br />CITY OF EVERETf LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify Ihat I have read and ezamined this application and know the same to be lrue and correct. All provisions of laws and <br />ordinaces governiny this lype ol work will be complied wilh whelher specified herein or not. The granting of a permi� does nol presume <br />to give authority to vioiate or cancel the provision of any olher state or local law regulating consWction or Ihe pedormance ot <br />construction. That I am auth zed by the owner of this property to perform the work for which application is made and I comply witl: the <br />State Conlractor aw 18.2 N and 296.20D WAC. �/ <br />� \ �'�/S�/�`����VI J �/ �7� l � <br />1/ <br />Z <br />8 <br />