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SITE ADDRESS <br />. �l <br />LEGAL LOT NO. <br />DESC. G <br />OWNER <br />. ^ 'll <br />� <br />TENANT NAME � <br />( <br />PtRMIT APPLICATIU6� <br />CITY OF EVERETT PERM17 SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />(YV`�� /�•t/. J D : �u� y i �_� <br />BLOCK TRACT OR SUBDIVISION M <br />?_ <br />f <br />FOR PERMIT <br />�. 5 <br />CONTRACTOR Auuntss ' <br />VaNS��`�r� ��sso�:�-�tis, i�� �:� ��� �=r5c� <br />CONTR. LICFNSE p <br />✓';N�L,4� o��ro <br />USE UF BUILDING HEAT SOURCE <br />S� _ Electric �Gas _ Olher <br />WORK DESCRIPTION <br />�`}r.{.C� � � �� n�- c'C �.,< < � <br />� �,.. � 1 � Gi�"d v �✓1GC t% �iCt <br />NO. I TYPE OF FIXTURE QR ITEM <br />Toilet <br />6alhlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwashcr <br />Clolhes washcr <br />Walcn c�ater <br />Sink (serviceNadmoplelc.) <br />�ackllow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease tr2p <br />Roo( drains <br />Other ( L L- /'i�e"i( ?/ <br />PHONE <br />�a..a3 —o� <br />PERMIT # <br />C o9i� - gio <br />i8zo/ <br />s 6� - �yiz <br />Ei� t��,.�-+- Y�� 06 <br />�� Z s- 6�70- � `// Z <br />CONTRACT PRICE OF WORK <br />��S;Obp <br />,: 1 <br />� �. S l� (i � �1 J Jj�. <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handlin9 units <br />For�ed air systems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Rangehood <br />Exhaust (an <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodalove <br />Other 2�r-It�,j� - i-��7�,1,�c !'�fl��c� <br />—� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />r <br />I hereby cerilify lhat I have read and examined this application and know lhe same to be true and correr.t. All provisicns of taws and <br />ordinacr.s c�overnin� Ihis type of work will be complied with whether speci(ied herein or not. The c�renting of a permil does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulaling construction or the pedormance of <br />consiruction. Thal I am aulhorized by the owner o( this property to perform the work (or which appiication is made and I comply with ihe <br />Stale Contrai.'tors Law 18.27 RCW and 296.200 WAC. <br />%� <br />� 2_�'C' <br />'lz <br />