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� <br />SITE ADURESS <br />'- 6 co <br />LEGA LOTNO. <br />DESC. <br />OWNER <br />��Q�J ��� , <br />TENANTNAME <br />� <br />PERMIT APPLICATION <br />CITY OF EVERE'9T PERMIT SERVICES <br />3200 CEDAR STREET, EVrRETT, WA 98201 <br />425-257-8810 — FAX 42:i-257-8857 — vwwv.everettwa.org <br />APPLICATIONS ARE F,CCEPTED FROM 8 AM TO 4 PM s— J I�D �f <br />PARCEL TAX I.D. p � P RMIT Jt <br />s�'� SI 2S' '02 � eo �l%��� <br />BLOCK TRACT OR SUBDIVISION N <br />AUDRESS CITV2IP PHONE <br />�I,� %f�.5� I�CONT C�FO PE Ml�e "CS�O"✓PHIN `U���L]�,--�9G l <br />T r< :v Mo�r.��rr,l,/ ; nus i I.j � <br />° i1rL� r����r�ri��ii�N A <br />�Pr�� C- <br />CONTR. LICENSE N�� � i� tn I�.` L I <br />1 f" <br />USE OF BUILDING <br />5 Tc � .a,9 �, <br />WORK DESCRIPTION <br />��L� <br />no ��7� w Z� <br />HEATSOURCE <br />_ Electric _ Gas _ Othcr <br />�S(oN a�Fl ZU�, <br />`�SoS�- z� �.•8Z-�l•�l <br />�CONTRACT PRICE OF WORK <br />//y3ev <br />,qOD 8 ;P��Nr��r ffz,4�,s 7� ,ve�� ,ti,��,��i,�r crr��� <br />t��� v� e.x�si�,dy ���i sysie,�, , <br />NO. I TYPE OF FI%TURE OFi ITEM <br />Toilet <br />Ba�htub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washcr <br />=Waterheater %�� 1 � <br />Sink (servicelbarlmopletc.) � <br />Backflow preventer �� � J <br />Urinal � /� <br />_ Drinkinc� Fountain � C� <br />/ <br />_ Floor drain j I -,,(� <br />Gmase trap � \ <br />_ Roof drains I -' <br />= Other ,�(�� <br />\�\ <br />N0. I TYPE OF FIXTURE OR ITEM <br />NC — air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas lireplacc <br />Gas range <br />Clolhes dryer <br />_ Range hood <br />Exhaustlan <br />/ _ Hcatpump <br />_ Unit heater <br />_ Boilr,r <br />Relrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />I hereby ceritity that I have read and examined this application and know the same lo be true and correct. All provisions ol laws and <br />ordinaces governing Ihis type ot work will be complied with wheth�r specilied herein er not. The granting ol a permit docs not presumc <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or ihe pedormance of <br />construction. Thal I am authorized by the owner of this property to pertorm the work for which application is made and I comply with Ihe <br />Slate Contractors t,Qw �Q.�2�W and 296.200 WAC. <br />�� W' 2 "� � <br />Signaturc of Owne oniractor/Authonzed Agent Dale <br />'/z <br />