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SITE ADDRESS_ <br />/ <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />rtk A�t <br />PEFtMIT APPLICATIO�V <br />CITY OF EVERETT RERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, V'.'A 98201 <br />425-257• 8810 — FAX 425-257-8R57 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />`:Vi i��U pqRCEL TAX I.D. p <br />N��c.�N R�. i -z��-yoi z��-��Z <br />IBLOCK TRACT <br />J ADDRE <br />`( IV �7�C'i�. _ I �c <br />r�� <br />-3 .-3�( -0.6 � <br />l✓� L�'03—��j <br />���,4��� � <br />ERMIT # T,'S� <br />-o6�z-o3z <br />PNONE ��7 <br />'� �� / �.�.A �4�f6Z <br />TENANT NAME //��� ^.� L�� �„�(i� CONTACT FOR PERMIT PHONE <br />��' <br />_�������,e� � I� � Zz 1�10� u�-2 z oC� � 4> 33y1 <br />CONTRACTOR ADDRESS CITY2IP PHONE <br />E%l���lC_r_,tw (�-r�7l� M��rk r�tl��uc' l3,SZ� SE �Z��''�sr. Zb�7�3337/ <br />CONTR. LICENSE p � N ��� C �n� 0�1� p� �, <br />USE OF BUILDING ( HEAT SOURCE <br />�_ <br />f'��� (J R � � _ Electric �Gas _ Olher <br />/T <br />WORK DESCRiPTION <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilel <br />Bathlub <br />Lavalory (wash basin) <br />ShoHer <br />Kilchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />W afer healer <br />Sink (service/badmop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher _ _ <br />CONTRACT PRICEOOF WORK <br />�"iG,gZG� <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas pipinc� <br />Waler heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer � , � <br />Ranne hood �!// < <br />Exhaustfan � <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 5705 <br />I hereby ceriti(y lhal I have read and examined this application and kno�v the same to be lrue and wrrect. All provisions of laws and <br />ordinaces governing this rype of work will be complied wilh whether specified herein or not. The granting of a permit does not presume <br />to give aulhority to violale cr cancel the provisio� of any other slate or local law regulating construction or the performance of <br />construclion. That I am aulhorized by the owner of this property to periorm the work torwhich application is made and I compiy wilh the <br />St�61e�nU ctors Law 18.27 CW a�d 29�.200 WAC. <br />Tjc�fii ;���«Z,bi,.�� > � ���lp <br />