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PERMIT /�PPLICATe�N <br />CITY OF EVERETT PERIVIIT SERVICES <br />3200 CEDAR STREET EVERETT WA 98201 <br />����� 425-257-6810 - FAX 425-257-885 % - wv�nN.evereitwa.org <br />�`- <br />V ��. APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />_ �— - ---- <br />SITEADDRE55 �%�`;Lti{- �_j�_.i•,, �'�.�1 PARCELTAXI.D # <br />�.4 0 -�---�J. � �.-.. � � --._.1�. �c <br />LOTNO. � BLOCK � TRACT <br />UESC. <br />PERMIT # <br />�� 1, �, (: <br />��E2�"f� C%tiNIL �D I �iOY� �iuL' Nu.E �26rT, C.�f1 19�201 9z5•�34• SY`d8 <br />TENANT NAME CONTACT FOR °ERMIT PNONE <br />ei+��s t.��+r� yzs.�-r5.`lu�� -- <br />CONTFACTOR �DRESS CIT`(TP PViONE <br />`v16+�YF-�-fF� ���'' GBop �ti1EE'Rtl._ QQ��K�KIyY. UL5•'175'7YyH <br />CONTR. LICENSE # ��� �,.,�r� t�� qg90 3 <br />s����r�-��9y6c'� % _ _ <br />USE OF BUILDING <br />WORK DESCRIP � N �� <br />� :<<,. <br />HEAT SOURCE I CONTRACT PRICE OF WORK <br />_ Elec7ic __ Gas _ Cther I � �,-�� , �, <br />/-� — - <br />��) - !N-�L��-u� r`��,1� �N,�,�� . <br />( 3 ) I�c,� i <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathfub <br />Lavatory (wash basinl <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (servicelbar/mopletc 1 <br />Backflovi preventer <br />Urinal <br />Drinwng Fountain <br />Floor drain <br />Grease trap <br />Roof dreins <br />Other <br />NY�'�i"�.�% Slt•r:a <br />� .I f.:ly 1-':�•t �'h:1L <br />NO. I NPE OF FIXTURE OR I7EM <br />A/C - air handling umts <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas renge <br />Clothes dryer <br />Rangehood <br />Exhaustfar <br />Heat pump <br />Unit heater <br />Boiler <br />ReMgeretion <br />Woodstove <br />Other <br />CIN OF EVERETT LOCAL SALES TAl( CODE IS �105 <br />� hereby centify tha[ I have read and examined [his application and Iv,ow the same to be true and correct. All proviswns of laws and <br />ardinaces, goveming ihis type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />m gwe authority to violate or cancel the pro ision of any o�er state or local law regulating consWcti�n or Ne peAormance of <br />1i uctio That I a o� e by the ner of Nis pmperty to peAorm the work fo� ich appiica6on is made and I comply vnth Ne <br />� tate Cenfr tor< La 1 B 2 R and 6 200 WAC <br />c�i' � -� . /� pd D6 � - <br />,iGna�vre of OwnedConfractorlAuthorized Agent D te �� <br />��� <br />