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SITE ADDRESS <br />LEGAL LOT NO. <br />DESC. � <br />OWNER 10�� <br />��CL�'Ie5 J <br />TENANTNAME <br />PERMIT APPL�^ATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-&857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # P MIT # <br />1 e.r�-�-4- 'J 0�i 330 �Uv I� Oa +� -L <br />BLOCK TRACT OR SUBDIVISION p <br />Nc�m a SP � I2oz-DD�-2�o � <br />ADDRESS CITY2IP PHONE <br />aailo a��N"`�S� r�� S-f��� �� l C3��Ns`� �5ia� <br />CONTACT FOR PERMIT l����� y-5137 <br />I`,` I/ l I' 1,, e,�%� /� <br />��../L I �F� "/ `� ���5 E-MAIL (� II !—P •! IL{��...� u IC= ��'l_ / Iti"1 <br />l�V1Y 1l1NV 1 V!1 r�vv��� <br />Ect��lk CDV,I�� CD1�S'!-�'t:cF-iCt�.lp� L <br />corlr.�. LICENSE #� 11 /, I � C C�� p� l�f � <br />rl l: I�� <br />USE OF BUILDING <br />cJ� h <br />WORK DESCRIPTION <br />��uilc� ��'W <br />�,p�( 13o�-I t1�ct �v�I1� (31�v)y5N-5/37 <br />�`-O� �U <br />HEAT SOURCE <br />_ Electric ��Gas __ Other <br />CONTRACT PRICE OF WORK <br />� �I�� 000 <br />si���� -i��mi I\ f ti c si �I en e� �,usi c_ �'��,, 3a i <br />NO. I TVPE OF FIXTURE OR ITEM <br />loilet �' � <br />Bathiub 1 / <br />Lavatory (wash basin) /� � <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Cbthes washer <br />LNater heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor dran <br />Grease trap <br />RooF drains <br />Other <br />NO. I NPE OF FIXTURE OR IIEM <br />A/C — air handiing units <br />—f Forced air systems <br />(,?� Gas piping <br />� Water heater <br />Gas tireplace <br />Gas range <br />� Clo�hes dryer <br />. � Range hood <br />��� Exhaustfan // / <br />_ Heat pump <br />Unit heaier <br />Boiler <br />Refrigeration <br />Woodstove <br />CIN QF EVERETf LOCAL 5ALES TAX CODE IS 3105 <br />I hereby ceritify Ihal I have read and examined ihis apptication and know the same to be irue and correcL All provisions of laws and <br />ordinaces governing ihis type of work will be complied with whether spe�ified herein or not. The gra'riing of a permit does not presume <br />to give authoriry to violate or cancel the provision of any other state or local law regulating construc'.ion or the pertormance of <br />construction. That I am authorized by the owner of this propeny to perform ihe work for which application is made and I comply with the <br />State Contractors Law 7827 RCW and 296.200 WAC. , , <br />�z <br />