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SITE ADDRESS <br />5`3 r � w'• H; <br />DESC. <br />PCRMIT APPLICA�IC�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />l,l��,.� 2�- <br />� BLOCK <br />� <br />��' m t K�� y KoSS <br />TENANTNAME <br />S a �r e. <br />CONTRACTOR fJ✓L�A�ZrI.-Ut�� <br />� ia <br />'�ON . UCEN E # � <br />,� k � � � i�-� P <br />USE OF BUILDING <br />�- .� c� �-� <br />PARCEL TAX I.D. # P MIT # <br />� on��tq oonaiSoo S L�ro�s� <br />TRACT f'ii,q�\ �cLhd �arms Z <br />✓ <br />.5 3/� �,�. �,q�l��d /�P <br />CONTACT FOR PERMIT <br />n <br />�� �� �.,�... � 1, ' <br />98zo� 3�7- <br />�u'� 4i? °"�io � o <br />-1S% I19 • J �7 J <br />�6 �9 <br />�W <br />ADDRESS CITYIZIP PHONE /�S` <br />_ 3 � u, ,z� � w-c1Ge: u.t n— �VtKkt1— �j b''�-o� � � <br />33 9-S� 33 <br />HEAT SOURCE <br />Electric _Gas��IJther <br />�CONTRACT PRICE OF WORK <br />' L� �o � <br />WORK DESCRIPTION � �y� pv.r G <br />�4 � n,�.- 1ti-� ,, �J � n n-.,...., . I r� �,., � n^ rr n•�.. / cr� a,u ,, ^-� � <br />t�iil r�rC. C.l�r� rT/ /31i��..r2'i+� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balh�ub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />CloUves washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflo�v preventer <br />Urinal <br />Drinking Founlain <br />Fleor drain <br />Grease lrap <br />Roof drains <br />Olher _ <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling unils <br />Forced air systems <br />Gas piping <br />Wa!er heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />I�ange hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Retrigeration <br />Woodslave <br />Other <br />CITY OF EVERETT LOCAI SALES TAX CODE IS 3105 <br />I hereby ceritity that I have read and examined lhis application and hnow the same to be true and correcL All provisions of laws and <br />ordinaces c�oveming this rype of work will bo complied with whether specified herein or not. The granting of a permil does not presume <br />lo give authoriry to violate or cancel the provision of any other state or Iocal law regulating consWction or the performance oi <br />construction. That I am uthorized by lhe owner of this property to pedorm the work tor which appiication is made and I comply wilh the <br />Stale Contraclors��J�327 RCW and 296.200 \NAC. � <br />1�2 <br />