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SITE ADDRESS <br />IEGA LOT N0. <br />DESC. ��� � <br />i <br />P�RMIT APPLICATION <br />�ITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8610 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />F'ARCEL TAX I.D. # <br />CU�'�:t <br />BLOCK I TRACT OR SUBDNISION A <br />I��1C11Ge I � N1A��ri �. �S�'�� <br />TENANTNAME <br />� I U C�Ct u n <br />CONTACT FOR PERMIT <br />nlaruc� �Se�lrx�� <br />�� ut�,: <br />�HONE <br />U 4 ' �O7 <br />U-)5 3��.7J `I <br />S. 3�g• 3y-71 <br />mavc� ai Q �msn. uYvj <br />l.V1Y1RNl�IVRNOYM�WaT"{-�CIOI nvvnou� �.��nur rnvn� <br />Gr�A{-fwood Lans+ruc�sv�, �.t.C. I5GlO L5�"At�� Snohomish, UlA �f15'� 3 38 � 5�5�i <br />CONTR. LICENSE M q gS.7 (� <br />GRAcrGw�iRz � �-ZI-U _ _ <br />USE OF BUILDiNG HEAT SOURCE CONTRACT PRICE OF WORK <br />}'� ���}� GQ il (,�\� I * Eleclric X Gas _ Other ^ I '� I/� � � O _ <br />WORK DESCRIPTION <br />� <br />��IU,Q,,Q. 'hC IU L,.M� <br />N0. � TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwashor <br />(;lolhes washer <br />Water heater <br />Sink (service/barlmop/etc.) <br />BackOow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Olher <br />E <br />N0. I TYPE OF FI%TURE OR ITEM <br />A/C — air handling units <br />Forced air syslems <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 heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TA% CODE IS �105 <br />I hereby ceritify Ihal I have read and examined lhis application and know Ihe same lo be true and correct. All provisions of laws and <br />ordinaces �overning Ihis type of �vork will be complied with whether specified herein or not. The granting of a pertnil does nol presume <br />to give authority to violate or cancel tho provision of any other state or local law regulating construction or lhe peAormance of <br />construction. That I am authorized by the owner o( lhis property to perform Ihe work /or which application is made and I comply wilh the <br />St�te Contractors Law 18.27 RCW and 296.200 WAC. <br />1 . � <br />� ((ii�•_��✓��_r.r�-��1. �'�y�1S <br />