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��. <br />ji�.. <br />SITF. ADDRESS <br />LOT NO. <br />� 23�G f <br />TENANTNAME <br />1 � <br />PLRMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 � <br />425-257-8810 - FAX �.25-257-8857 - www.everettwa.org �- 6�� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �iC� ��' (JQ7 <br />/,, PARCEL TAX I.D. A ERM/I/T K <br />/�v DOS6'7?�D?�UD/ � /�S��S <br />BLOCK 1 7RACT <br />CONTACT FOR PERMIT <br />� <br />y2s-�sy-csz� <br />iGa�rG �z-,�ra�Rey NZs 7Sy-�5�7 <br />CONTRACTOR ADDRESS CITY2IP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEATSOURCE <br />_ Electric �Gas <br />WORK DESCRIPTION T/�[�,�K\N f Co,J,uiT FoC Pu R, PYOJS� <br />C���tcT Tv �fly'�'L./G\ S�WJR sTt/S . JdNfCT Tb <br />c�� TRµCTtV�/Of Buzc.U�.JG AvD Poa�r. c'.u..��JCf <br />Riwo�l oy3lfilf�4a PoJ32 trd ot3 �4Y PuA). �1 <br />NO. I TYPE OF FIXTURE OR ITEM <br />l oilet "� <br />Bathtub I <br />Lavatory (wash basin) (�u <br />Shower I/ <br />Kilchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/banmop/etc.; J <br />Backflow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Groase trap <br />Roof drains <br />Olher <br />CONTRACT PRICE UF WORK <br />� � i/A'rt GAS� f� PoelfR <br />Tt/l. ty�j�oyJ 11�edfi, <br />lSYtalS—S'rDQW aCAL✓, <br />= I.� � ,(�DU S F _ <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC — air handling units <br />Forced aIr systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan �(�/� <br />Heat pump <br />Unit heater <br />Boiler <br />Reirigeration <br />Woodstove <br />Other _ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />I hereby ceriti(y lhat I have read and examined this application and know lhe same to be lrue and correct All provisi.,��s of laws and <br />ordinaces �overning ll ' lype of work will be complied with whelher specified herein or not. T�ie granling of a permil does not presume <br />to gi uthority to vi a�cancel the provision of any other slate or local law regulaling cons!ruction or the per(ortnance of <br />co tru tion. Thal I nzed by lhe owner of lhis property to periortn lhe work for which applicalion is made and I comply with the <br />ate ontraclors a 1 7 RCW and 296.200 WAC. <br />Zt�07 <br />� � <br />� �/,� � � �% �' (� <br />