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� PtRMIT APPLICATIdN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 I <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org \ <br />SITE ADLIRESS <br />( � - (.; - �.1 <br />LEGAL LOTNO. <br />oesc � Z <br />OWNER <br />� !u R �? /1 � �' <br />TENANTNAME <br />U��2A <br />�J <br />APPLICA710NS ARE ACCEPTED FROM 8 AM TO 4 PM <br />I PARCEI TA% I.D. t! <br />�=11 � C�'Z�i7U� <br />DLOCK TTRACT OR SUBDIVISION d <br />� I�,' i.`Z A c. T� c(� <br />CONTRACTOR <br />�r ��-��r �� <<N��,•�n���,��J <br />CONTR. LICENSE u <br />USE OF BUILDING <br />�n,� r, �1_ C� ,-1 0� 5� ��- � � P <br />WORK �ESCRIPTION <br />`1-L � �l ^%� <br />�i �.j �C'-�� <br />� P�c <br />i n; L_ 7`I � 1" � v( <br />(CONTACT FOR PERMIT <br />I z_ D �� J +—�i <br />AUUNtJJ <br />��'��J S. Zo�-t� <br />"h^ <br />NEAT SOURCE <br />_ Eleclric _ Gas <br />2 �' �' h"G7. 00�-�1`� c�v <br />�� PERMIT q J /� <br />�_� � � �C�il `C�(,',� <br />� i�/,<�-.� ��� �1F�6✓�`� <br />CITYIZIP PHDNE <br />St S �% (;v t w.-CSl , �"I� <br />P�E ��7� <br />(7_uE�z�3 �Ziyq�Z :, <br />� CITYIZIP rnone � J� S t v�{'y <br />S t � t�� �; � �t�q , � <br />C'l �-�,. c� 3 "Z <br />CONTRACT PRICE OF WORK <br />Other ( � (� r `J �7 � <br />i.�n p(L��/� I`��).,i-( jb L�C � ST r�G �i �t i `7��.2 <br />' I�% /1 ��� M v D fl� t !`� L"`' (� � I t� i.'V'L'. <br />F��� �'���p, �J(- � <br />_. ..__..._ u�crueuirte <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />EatMub <br />Lavatory (wash basin) <br />Shower <br />Kitch?n sink F. Aispos�l <br />Dishwasher <br />Clothes washer <br />Water healer <br />Sink (serv�cePoarlmop�etc 1 <br />Bacl:fiow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roo( drains <br />Olher <br />„��G � �'(� <br />� WA �� <br />NO. I TYPE OF FIXTURE OR ITEM <br />A1C — au handling unils <br />F�rced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Range hoad <br />Exhaust lan <br />Heat pump <br />Unit heater <br />Boifer <br />Relrigeration <br />Woafstove <br />Other <br />{�� F,:1 ( S i'�L � 1J �� lt �i- <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 _ <br />I hereby certdy Ihat I ha:�e read and examined th�s app6cotion and know the same to he true and correct. All proviswns ef laws and <br />ordinances governing Ihis type o( work will be complied with whether specified herein or not The granting of a pem'�it does nol p^ea^me <br />lo c�ive aulhority lo violate or cancel Ihe provision ot any other state or locat law regulating construclion or lhe periormance ot <br />construction Thal I am authorized by �he owner ot Ihlc property to perionn lhe work for which application is made and I cornply vnth lhe <br />S(ate Conlractors Law 1827 RCW and 296 2U0 WAC I <br />� . .-�; _...� � / ��(P�� <br />Signature ot ChvnedContraclor/Aulhonzed Agen� a�e � <br />Z <br />