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SITE ADDRESS <br />� r <br />LEGA LOT NO. <br />OESC. <br />OWNER <br />C NAN, NAME <br />5`T �ia�11 f�e <br />� � <br />CONTR. LICENSE M�' <br />�� <br />USE OF BUILDING <br />��� �oan <br />WORK D SCRIPTIOD <br />P�r2MIT APPLICATIanI <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <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. N <br />� <br />BLOCK TRACT OR SUBDIVISION N <br />i+DORESS <br />� LG _ i69/v���c�.t�" <br />CON ACT FOR PERMIT <br />�JP�y i ll <br />L l <br />fi'YI.. �����Y /! .iOS- S LLimCle! <br />�"V C�YL�u-f 5'C Gl�/ <br />I HEATSOURCE <br />-�, � i�' Ko�d <br />_ Electric <br />(�Yi��'I <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />�alhtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/Uarlmop/etc.) <br />6ack0ow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease irap <br />Roof drains <br />Other <br />Gas Other <br />PHONE <br />6 �3 <br />PERMIT # <br />r ��,� WI� �8� 3 X <br />CONTRACT PRICE OF WORK <br />�R�'v� <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas renge <br />Clothes dryer � <br />Range hood /2 <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />�t/ake un �A rr <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certity that I have read and examined Ihis application and know �he same �o be true and correct. All provisions of laws and <br />ordinances governing Ihis �ype of work will be complied with whelher specified herein or not. The granting of a permit does nol presume <br />to give authority to violate or cancel lhe piovision of any other slate or local law regulating consiruclion or the pe�lormance of <br />conslruction. Thal I am authorized by the owner of this property to peAorm the work (or which application is made and I comply with ihe <br />Slale Coniractors Law 18.27�d 296.200 WAC. , <br />� - �/7-Y� (J <br />/� <br />