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SITE ADDRESS <br />� �j EcJcQE� <br />LEGA LOT NO. <br />DESC. <br />PERMiT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CED/�R 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 />BLOCK <br />PARCEL TAX I.D. # <br />2�'os ISo� �� <br />TRACT OR SUBDIVISION # <br />k <br />OLa -(�l <br />`t�`3 Pz�S��� c���- �•aa� i�r�l n�� � ai�, r�.�u.��- �t�, 2� z�s1 �� I <br />TENANT NAh1E CONiACT FOR PERRIIT PHONE Z�, �(�>) � �SZ"L I <br />"�.!ico �{l.T�ct=��at� CiC-�:C- IkdkArir�k-� E-MAIL.1�1fL�c,-K.s7��iY-�Hr�1�� r,.--� <br />CONTRACTOFi A�DFiESS CITY/Z1P PHONE I <br />7�k2Z �,j:.-P�JI�`� F'v. fX%7Z 23`>�I' .cl-ff-INC� ,`f"�� i� 2S3" ZSD ��j`-�' II <br />CONTR. LICENSE # �2Z,jC5��'�'�JC��J <br />USE OF BUILDING <br />G(=Flc�:=. - � <br />HEkTSOURCE <br />_ Electric _ Gas _ Other <br />CONTRACT PRICE OF WOfiK <br />�, ���c��o.00 <br />WORK DESCRIPTION <br />17�-i::. �..c�"ft-'CI��T I-�:� f7��'�t-r� f31'C�iTT1a-y� �G��- �-aF- T`a�/'e�T �H�UtH�r-'�=� <br />�� �' �IJ <br />NO. � TYPE DF FIXTURE OR ITE�d <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 dispnsal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (servicelbarlmop/etc.) <br />Backflo�v preventer <br />Urinal <br />Drinkino Fountain <br />rloor drain <br />Grease trap <br />Roof drain; <br />Other <br />N0. I TYPE OF FIXTURE OR ITEId <br />AIC - air handling units <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gasrange <br />Ciothes dryer <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />1Noodstove <br />qN OF EVERETT LOCAL SAIES TAX COCE IS 3105 <br />I hereby -eritify that I heve read and examined �his application and know the same to be true anj correct. All provisions ct laers and <br />ordinaces go:�erning this type of work will be compf;ed v.�ith whether specified herein or nm. The granting of a permit does r,ot presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the per(ormance of <br />consirucljon. That I am authorized by the owner of this property to pedorm ihe work for which application is made and I comply with the <br />State Contractors Lay+'f8-2Fj RCVJ and 296.200 WAC. <br />� � �� U� / <br />Date � <br />�� <br />