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SITE ADDRESS <br />`{25 r� <br />LEGAL LOT N0. <br />DESC. <br />OWNER <br />: Uh �Ub1 <br />T NANT AME <br />%10hB <br />CONTRACTOR /��� <br />� <br />CONTR. UCENSE �I <br />USE OF BUILDING <br />p� <br />� <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SE�•✓ICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8Ei10 — FAX 425-257-8657 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK <br />lC- �, i C�'�1� <br />> 1��. � ic{ <br />PARCEL TAX I.D. # PERMI � �/� <br />2S0`f'120D'20� - 20o J j % <br />s�� <br />CONTACTFOR <br />PHONE <br />AU�RESS� � '1 . CITYIZIP _ PHpNE <br />f�'�c_h �L� ������. ,�,., - ,���'7 �.5`7 <br />HEATSOURCE <br />_ Elecinc � Gas _ Other <br />CONTRACT PRICE OF WORK <br />�I] <br />W/O�R�KDESCRIPTIO� ^ a �• `G ��� 4,/S48 S'�• VGt"pl.�.Q � W! <br />l.v�.S}vuc �='i �'�� <br />t�vivc--Hnw w��clow la-u..e a��f Pa.v�/� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sinh. (servicelbarlmop/elc.) <br />Dackflow preventer <br />Urinal `. <br />Drinking Fountain � - . <br />Floor drain _ <br />Grease trap <br />Root drains <br />Olher�" �, w�� <br />NO. I TVPE 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 range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heaiar <br />Boiler � <br />Refngeration �` <br />Woodstove . <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J705 <br />I hereby centify that I have read and e<amined Nis application and know the same to be true and correcl. All provisions of laws and <br />ordinaces goveming this type of work will be complied with whether specified herein or not. The granting of a pertnit does not presume <br />to give aulhority to violale or cancel the provisicn of any other stale or local law regulating wnstruction or the perTormance o( <br />construction. That I am authorized by the owner of ihis property to perform lhe work for which application is made and I comply with the <br />State Contractor w .27, f2CW�d 296200 WAC. <br />C� <br />