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SITE ADDRESS <br />110 SC- GVzti° <br />LEGAL LOT NO. <br />DESC. <br />P�RMIT APPLI�ATIC,N <br />GITY �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 />PARCEL TAX I.D. # <br />�� <br />BLOCK I TRACT OR SUBDIVISION # <br />��p—D <br />PERMIT # <br />OWNER ADDRESS c:IIYI[ir rn�ne �� ���. /,� <br />�`I <br />`�a���i� �l�> ce��-f�a- Ll,- c- ho I� 3�� fr��lc«��l ��Bzaq <br />TENANT NAME CONTACT FOR PERfdIT PHOMF. <br />`�� � ��'f/3-�> 3��, , ����o <br />SGtl�l') I/O1CG�- J"I"%��1iL �.�CYl�llj'QS E.MAIL <br />CONTRACTOR ADDRESS CIiY/ZIP PHONE ` Ib� <br />��13'�T �Sic�r. �u(vi�2� 1t�a� z ��v+��� C-V=,,re-tti-4lwy +Fv� M�I�I�'ee� �f4'��z 4Z= 2�'`� <br />CONTR. LICENSE # _, _ _ � � _ <br />USE OF BUILDING <br />SE'�I'�V c-C <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />Electric Gas Other � q' , �n <br />WORKDESCRIPTION ll (,e}j'-e.�/' C'�IS�' I <br />�hs�a ore- C-ha���'�.e.-I ►' � <br />N0. I TYPE OF FIXTURE OR I'fEM <br />Toilel <br />BathWb <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Cblhes washer <br />Water heater <br />Sink (service/badmop/e <br />Backflow preventer <br />Urinal <br />Drinking Fountain � <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handlinc� unils <br />Forced air systems <br />Gas pif.ing <br />Waler heatcr <br />Gas fireplac: <br />Gas range <br />Clolhes dryc�.r <br />Range hood <br />Exhausltan <br />Heat pump <br />Unit heat <br />Boiler <br />ReGigeralion <br />Woodslo�e <br />CITV OF EVERF.TT LOCAL SALES TAX CODE IS 9105 <br />I hereby cerilify that I liave read and examined this application and know the same lo be true and correcL All provisions oi laws and <br />ordinaces go�eming this type of work will be complied with whether spacified herein or not The granting of a permit does not presume <br />to give authnrity to violate or cancel the provision of any other stale or local law regulating construction or the performance o( <br />construction. That I a utf rized by the owner of this property to perform ihe v�ork for which application is made and I comply with the <br />Slate Contiaclors L � 7 RCW and 296.200 WAC. <br />' � < po <br />SignaWre o( Own Coni aclodAulhorized Agenl Da �/ <br />l oZ' <br />