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SITE ADDRESS <br />LEGAL LO� <br />DESC. <br />E��RMIT i4PPLIiL:ATi(�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.c�rg <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />���.t,i' 3�.},b I Pl.RCEL TAX I.D. # <br />f�� �i <br />BLOCK TRACT <br />NER y.{il�j A�UKtSS � /_ `^m �.i <br />jti� ?� P�°P LL(� z�o-r r. � r Y� <br />nl;.w'/ 'V�fi � <br />'�ENANTNAME <br />PERMI'� <br />CONTRACTOR AUDRESS CITYIZIP <br />�/1.151..1'�1/�%L niBlli�'�1s Z fjO7 �. �s+1uG �A/H��,. 1 <br />CONTR. LICENSE # P/LyL,� � SD�INNL�f/11� S/'� <br />.�/ ,Y07N <br />USE OF BUILDING <br />WORK DESCRIPTION���1 n <br />�p,'�c�a✓ �t- Y',s ]! <br />�f �ts �);�p%�. �v✓ <br />.,, ,,..-.,� <br />HEAT SOURCE <br />Eleclric _ Gas _ Olher <br />�f,� 0� c,v,, � �` k5fo� 1/ <br />�G" �oti-v��.H,`� <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilel <br />BathWb <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Waler heater <br />Sink (serviceNadmop/etc.) <br />Back(low prevenler <br />Urinal <br />Drinking Fount.3in <br />Floor drain <br />Grease trep <br />Roof drains <br />Other _ <br />a �� <br />PERMIT # <br />07d� -���J <br />i�2s-- ��Hz <br />PHGNE <br />2v6-77�1—b�Y <br />PHONE <br />�/2S�Ll�iZ <br />v - � <br />,�ONTRACT PRICE OF WORK <br />�� �� � �� <br />2 N1 w �fh. �Gt hg � /hSfevl� <br />�;,.� plac� ,` � G'v,'� i2.00c � <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — 2ir handling units <br />Forced air systems <br />� Gas piping <br />Water heater <br />� Gasfireplace <br />Gas range <br />� Clothes dryer <br />Rangs hood <br />� Exhauslfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify thal I have read and examined this application and know Ihe same lo be true and correcL All provisions of laws and <br />ordinaces governing fhis type o( work will be complied with whether specified herein or noL The granting of a permit does not presume <br />to give aulhority to violate or cancel the provision of any other slate or local law regulating construction or the performance oi <br />conslruction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with lhe <br />Stale Contractors Law 18.27 R W and 296.� WAC. <br />/�., �� ��..:,:::=. Z�d%�' <br />Signature�o O— dConlracto "[horized Agent �%Date � �/� <br />� <br />