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f <br />PERi�AIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425••257-8&10 — FAX 425-257-8857 — www.evensttwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. # <br />��ii� N����c,r_u r,u�fl, ��,�� t� e �� �G�i.£_�/cl-�,� l-aa 2 <br />3 —a S�o. <br />PERMIT M <br />� o���� - <br />LOTNO. BLOCK TRACT/�)p�i�Li/N:i: 6�/E[a/ /:GJ//�YStS Cr_i6iG� .�I/C'i�/C�ti� <br />L,r, '7 _ ii�r✓�,r•) .�,fE iLne✓ i�.�:-.��1 �:wki�i;�,im;nr��l� /�„��*-;r,eximr�� � <br />Ts���r' � �-„e� �a�G� .�r�c. <br />TENANTNAME <br />�vt�uli�-1 /�rn.ai� ���,U��1 <br />CONTRACTOR <br />�1/.//iL %E/i �/t;�i�/1/.b, 1N[� <br />CONTR. LICENSE # <br />r31�TL Cf_'���_� <br />USE OF BUILDING <br />WORK DESCRIPTION <br />/L<0 i iYW.�/?>»ii1/�o7)iGN L'/�. L�.'�iAQU'RN <br />!�v!(1- *� l07 %;fD1-7 <br />ICl� �c. �i,rf��r <br />5��7- 77k� <br />PHONE <br />`12S`-75'D' _5 1Z7 <br />ADDRESS CITY2IP PHONE <br />�,�iz ; Nu.�✓ �✓ U���,�sn tr'�1f1 !✓A �,�•i �in ��m �� � <br />3� <br />HEATSOURCE <br />Electric .� Gas _ Other <br />CONTRACT PRICE OF WORK <br />�1�, rI57J `� <br />.Z�iJ/�%ir'-L i,aJi�n/r z�iv�iavc��i�,, � ro ��rNrc;�� L��E � /� <br />' 4� ' f � �F��>%!�F _� <br />/it:�?rtu�/�i�!'. TD id✓� t;3� A�o:v _; ri ce: c, vrrL //flLFi r e:� .�, <br />/�i�i� liu��;�vt(.��riL•;v oF iLt�i>iwimvr' .�cav�FnaCn.T <br />N0. I TYPE OF FIXTURE OR ITEM <br />•Toilet , ' ' <br />Bathlub <br />Lavalory (wash basin) <br />Shower <br />iCitchen sink 8 disposal <br />W aler he:�ter <br />�/ Sin,<(service ar/mop/etc.) <br />� BackOow prc� e� ��� <br />Urinal - - <br />Drinkinc� Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />.�. Olher F/,^nl !>�.olC <br />,� `-:ik.�;�-,;�r; 1��hlUf_ <br />e <br />�i� <br />TYPE OF FI%TURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Waler healer <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heal pump <br />Unit hcater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that 1 have read and examined this appiicalion and know the same lo be lrue and correct. AII provisions of laws and <br />ordinaces governing this lype of work will be complied wilh whether specified herein or nol The granting of a permil does not presume <br />lo give authority to violale or cancel Ihe provision o( any ofher state or Iocai lavi regulating consiruction or lhe pedormance of <br />conslruction. That I am aulhorized by ihe owner of this property to perform the work (or which application is made and I comply wilh lhe <br />Slale Conlraclors Law 18.27 RCW and 296.200 WAC. <br />i:j / � <br />�_ ;Lt�LL _u.-z./ "'�/0�2ctG <br />