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SITE ADDRESS <br />�jov ��'I�.J,S�.-. <br />LEGAL LOT NO. <br />FcRMIT APPLICATIVN <br />CITY OF EVERETT PERMIT SEFtVICES <br />'2�;'.i CEDAR STREET, FVERETT, WA 98201 <br />4'S-7`,7-:i810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />5 l • e.�cre{{ <br />BLOCK <br />I PARCEL TAX I.D. # <br />S5'Zc j Op j`1 j jtJ006 I(> O <br />TRACT OR SUBDIVISION # <br />I Lv"L- �-Ob <br />i�U /Dl;�-C>D/ <br />�- J9--�D <br />�RMIT # <br />,Q9/� -OZD <br />AIcF fi�✓�`�I��� �-lui �e✓e�l-� �,� t} � <br />-E�o.� R�to3 `{zs- z95-t��� <br />TENANT NAME I CONTACT FOR PERMIT PHONE uZS- .ti� ry�•�� 5 �� <br />wrvinn�ivrc <br />A�fy( �aVC�GI��J�- <br />CODITR. LICENSE # <br />USE OF BUILDING <br />'=�;�.��t F��.,.,�ly `1u�nne <br />WORK DESCRIPTION <br />r`r,,,} F(r.=�,-� <br />� <br />NO. I TYPE OF FIXTUft[ OR ITEM <br />Toile� /// <br />~2 Balhtub � <br />�� Lavalory (wash basin) //�� <br />�_� Shower / <br />_� Kitchen sink 8 disposal <br />�_ Dishwasher <br />,�_ Clo�hes waslier <br />��] Waterheater <br />T Sink (service/bar/mop/etc.) <br />6ackflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />�i Roof drains <br />Other <br />�.��.: �7U'`�S � `� J� <br />� �,J:..2•�f � ' ,�.4�. . <br />qlta �-K�r�aeT A <br />HEAT SOUftCE CONTRACT PRICE OF WORK <br />Eleciric x�Gas Olher <br />NO. � TYPE OF FIXTURE OR ITEM <br />NC - air handling units <br />Forced air syslems <br />Gas piping <br />Water healer, <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan //�� <br />Heat pump <br />Unil heater <br />Boiler <br />Re(rigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined this applicalion and know the same to be irue and correct. All provisions of laws and <br />ordinances governing this type o� work will be complied wilh whelher specified herein or not. The granting of a permit do?s nol presume <br />to give authority lo violate or cancel the provision of any other state or local law regulating construction or Ihe periormance of <br />construction. That I am authorized by ihe owner of this property to perto: m lhe work for which applicalion is made and I comply with ihe <br />Stale Contractors Law 182 RCW and 296.ZOO WAC. <br />�'l� "\�--� i2/lti�ol <br />Signature of OwnedContraclor/Authorized Agent —J� � <br />/Z <br />