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SITE ADDRESS <br />:�2%S <br />IEGAL LOT NO. <br />DESC. % �Y- �, <br />P�RMIT APPLICATION <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 />/1 PARCEL TAX I.D. i{ PERMI <br />/ZD ixi �t � iy-vL� DC> �� C� /S �J'7 2t�0 7C�U � U� - J� <br />BLOCK TRACT OR SUBDIVISION p <br />y7Z �.APITbL 1-Iv� A�c� <br />ADDRESS CITY2IP PHON[ <br />�)L��^IV ZZ�� ��/Nl�� f-f+lL �ve2rTS�.Ji�Ql �Cr�57��� <br />TENANTNAME CONTACTFORPERMIT PHONE <br />E•MAIL <br />TRACT .����� G4�?dLCi ,uC D 5 I I IP P y2j Sv� y7� <br />2�2�> lZ�cr�2 �-+c EVcn.ET w� <br />CONTR. UCENSE # �jyt i FGi U Ei��'� <br />USE OF BUILDING <br />�--_Y ,'i ��o �i <br />HEATSOURCE <br />a��NL <br />_ Electric _ Gas _ Olher <br />WORK DESCRJPTION <br />CUn,_,i!'�c,— 57(, I�j Oe":f+-c%-t� <br />� � r `� ,_(>� � Sy-'l1,'t ` <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />BalhWb <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Wale. hoater <br />Sink (service/bar/mop/etc.) <br />BackOow provonter <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />6a.^1+�c,� <br />CONTRACT PRICE OF WORK <br />G �� C�17� . <br />TYPE OF FI%TURE OR ITEM <br />AIC — air handiing units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Cialhes dryer <br />Range hood <br />Exhaustfan <br />Heal pump <br />Unit heater <br />Boiler <br />R>Irigeralion <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify ihat I have read and examined Ihis application and know the same lo be truo and correcl. All provisions of :,.ws and <br />ordinaces governin� this type of work will be complied with whether spocified herein or nol The granling of a parmit does nol presume <br />to c�ive authority to violate or cancel the provision of any nther slale or local law rec�ulating consWclion or the peAormance of <br />conslruction. That I am authorized by the owner of this property lo perform the work for which application is made and I comply with lhe <br />Slate Contrayto�'L�u� 78}�7 RG44' eind 29�.2001'VAC. , <br />3/z�(o� <br />�/L <br />