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SITE ADDRESS <br />I 3 �I <br />LEGAL I.OT N� <br />DESC. Z _ <br />P:.�MIT APPLICATIG.J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-88�7 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />ilT�o CU4 oosos�0000�3 � i <br />BLOCK TRACT OR SUBDIVISION # <br />M,a-nLr H �t6t+TS <br />�{ � S �-i � <br />MIT # <br />STt=�/e �/ S,4NIC� Ti4c(,Mqti/ l 3yI Mui<t�rr� 6Cv;� �'vi��i� _ <br />TENANTNAME CONTACTFORPERMIT PHONE L�/ZS S�/�/-S3S3 <br />T��� ��I��S E-MAILL�%�IS C'�N� � Co�n <br />TRA TOR ADDRE 5 ITYIZIP PhONE <br />LvoNii 5 C�/SMvC7Jo'v yq2o �6q f'� yZS-3v�/-S3s,� <br />CONTR.LICENSEM� �^� r��� p� iqvr be, S�oNoM�SN fJ�9 `�� 29�0 <br />USE OF BUILDING <br />(���v2t� 6r-� <br />WORK DESCRIPTION <br />7 <br />HEATSOURCE <br />_ Eleciric _ Gas _ Olher <br />CONTRACT PR!CE OF WORK <br />��� <br />Nc� ���s72vCY� o�.� �F � � -C.� 2 �A2��e <br />:�i,r� <br />NO. I TYPE OF FIxTURE OR ITEM <br />Toilet <br />DalhWb <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink 8 disposal . <br />Dishwasher <br />Clothes washer <br />Waler healer <br />Sink (servicelbadmopletc.) <br />BackOow preventer <br />Urina� <br />Drinking Founlain <br />Floor drain <br />Grease irap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />NC — air handling units <br />Porced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Clo�hes dryer <br />Range hood <br />Exhaust (an <br />Heat pump <br />Unit hea�er <br />Boiler <br />Refrigeralion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES T�X CODE IS 3105 <br />I hereby certify Ih� have read and examined this applicalion and know the same to be irue and correcL All provisions cf laws and <br />ordinances govemi g �his typa of work wil� be complied v�ith whelher specifed herein or noL The granting o( a permil does not presume <br />to give authority lo �olate or cancel Ihe provision o( any olher sta;e or local law regula�iny construclion or the peAormance of <br />construc�ion. Thal I n aulhorized by the owner of ihis property to perform Ihe work for which application is made and I comply wi�h the <br />Stale Coniraclors L 1827 RCW and 296200 WAC. <br />- 3�i z cd <br />Signature OwnedCo rirac�odAuthorized Agen� Dalc 1/� <br />r <br />