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SITE ADDRESS <br />y.as- <br />LEGAL LOT N0. <br />oesc. 3 ; y <br />OWNER <br />TE A.S wl E M <br />TENANTNAME <br />PERMIT APPLICATION �e,� rr� R� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 1 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D.1t PERMIT N <br />G�A�1� �vE oor �-1�3��3a� ' �/� -6/l� <br />BLOCK TRACT OR SUBDIVISION p <br />�-�� P-�aoy c P�b [0 5�to �o� <br />3�eg v�ntssto�! E <br />CONTACTFORPERMIT <br />� ^^ Fl k-Y�R'f <br />vnARYSVIU.G �'� `IA? <br />PHONE 3�C. 619.94y1 <br />EMAIL .1"�l�'LJM11QnS�lw' <br />CONTRACTOR AOoqE55 uniur �rnunc • <br />(_p�ore.l5 [o �.CS'['evc�en� <br />y12a r41� A� sE s�(otton�s{}� wA 7�z'lo <br />CONTR. LICENSE p��M t`�I61 p� y2r T�l N. ri S'3 <br />USE OF BUILDING <br />HEATSOURCE <br />S� �S� n E� �� I _ Eleciric �, <br />WORK DESCRIPTION <br />t . �a� STw,��n,•,( <br />FAWIIL`� �?'ES�D��� <br />NO. f TYPE OF FI)fTURE OR ITEM <br />m <br />Toilet � � � <br />Bathtub 1� <br />Lavatory (wash basin) � � 11 <br />Shower j <br />Kitchen si�k 8 disposal � <br />DishwasheK <br />Clothes washer ` <br />Water heater <br />Sink (service/badmop/etc.) t <br />BackOow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Greasetrap <br />Roof drain, <br />Other <br />Gas <br />CONTflACT PRICE OF WORK <br />Other �'Z i� �o o �/ <br />,r „�E„u 2�SNN tl�' Sr�lpt� <br />NO. I TYPE OF FI%TUHE OR ITEM <br />NC — air handling units <br />Forced air systems � <br />Gas piping <br />Water heater <br />Gas fireplace � <br />Gas range <br />Clothes dryer � <br />Fiange hood <br />Exhaustfan � <br />Heat pump ' � I � <br />Unil hcater <br />Boiler <br />Relrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 7105 <br />that I have read and xamined ihis application and know Ihe same to be true and correct. All provisions ol laws and <br />�ning Ihis typ of wo will be complied with whether specified herein or not. The granting of a permil does not presume <br />� �o v late o ancel 1 e provision of any other state or local law regulating construction or the performance ol <br />iat I«�ut o ized y he own I this property to perform ihe work br which application is made and I comply with Ihe <br />rs w 78.2 CW .200 W/1C. <br />I I — I?—ZoeB <br />+n � o racto .uth � .d Agent Date / <br />l Z <br />