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P�RMIT APPLlCATIQN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STRE[T, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APF�LICATIONS ARE ACCEPTED FROM 8 AM TO 4.'M <br />SITE ADDRESS <br />23os No�,- �E <br />LEGAL LOTNO. BLOCK <br />DESC. <br />OWNER <br />Tiz�u�r�- CA,.xo��t� Cuka <br />TENANTNAME <br />N G� <br />CONTRACTO T9D <br />CONTR. LICENSE # <br />USE OF BUILDING <br />C l�ta rLC. N <br />WORK DESCRIPTION <br />PARCFL TAX I.D. # <br />TRACT <br />23U I 1�1oFrf <br />CONTACTFORPERMIT <br />ii�T2�C✓ �A <br />ADDFESS <br />HBATSOURCE <br />Eleclric �/ Gas _ Olher <br />, <br />' � �� <br />�� <br />��s�-�^ ��n � -'�-, ; / . 'b: �i a <br />� <br />N0. I NPE OF FIXTURE OR ITEM <br />�_ <br />Toilel <br />Balhlub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />W aler healer <br />Sink (service/badmop/elc.) <br />BackOow preventcr <br />Urinai <br />Drinkinr� Founla�� <br />Floor drain <br />Grease lrap <br />Roo( drains <br />Olher _ <br />PERMIT # <br />� ��(��0 7 -o � <br />CITY2IP PHOYE <br />,Jtv�E'r—r i`izs ZS�-�i12` <br />PHON <br />C4�) 4a� -Zssy <br />CITY2IP PHONE <br />CONTRACT PRICE OF WORK <br />3 �7-'� �� �i <br />_� <br />NO. I TYPE OF FIX'tURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range fiood <br />Exhau�tfan �� <br />Heat pump '�� <br />Unit heator � <br />Boiler <br />Re(rigeration <br />Woodslove <br />Other <br />CIN OF EVERETT LOCAL SALES TAX CODE IS J105 <br />I hereby ceriCfy that I have read and ezamined this applicalion and kno�v the same to be true and correcL All provisions o( !2ws and <br />ordinaces goveming lhis lype of work will be complied with whelher specified herein or nol The granling ot a permit does nol presume <br />lo give auth9 �ty to violale or cancel Ihe provision of any other slate or local la�v regulaling conslruclion or the performance o( <br />conslructi6n. T%ial I am ;�uthorized by lhe owner of this property lo peAorm the work tor which application is made and 1 compty wilh the <br />State Cnn:ractors,Law�9.27 RCW and 296.200 WAC. � � <br />