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ADDRESS <br />�D `� 11.� <br />L LOT NO. <br />G-v/� x'+ N <br />TENANT NAMI <br />� <br />CONTRACTOR D13 �L <br />PE�r2MIT APPLICATIOIv <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 />PARCEL TAX I.D. # <br />/ �� ,D <br />BLOCK TRACT <br />ADDRESS <br />� .�`ao�i w /v1y <br />CONTACTFOR PERMIT <br />,. � � <br />�cQU���, � <br />CONTR. LICENSE p���� L/2 � <br />/LL ,�i� <br />USE OF BUILDING <br />WORK DES RIPTION <br />-� n 5�� // g`,� a � <br />��i Id��� n <br />y� i%/'P rr�;�, <br />03 - /D <br />,�,5 . �sa � <br />o �� <br />PHONE <br />,3e3G-��9 � 3s�a <br />ADDRESS CITYIZI PHONE <br />i��3�aiy�-i��t��l�-/3/ �✓�.��,1/� wti �/,�s-��s <br />�%� <br />HEATSOURCE <br />._ Electric _ Gas _ Other <br />CONTRACT PRICE OF WORK <br />� ,/lx� �' ,— <br />/ / 1,�,�. /� �� <br />l✓�,lG� i� CG�'�Pr o/�I lcn�iP fe S��t � Ir� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhlub <br />Lavalory (wash basin) <br />Shower <br />H :hen sink 8 disposal <br />L�:. .�vasher <br />Clothes washer <br />V✓a�er healer <br />Sink (servi�e/barhnoplelc.) <br />Backllow pr�venter <br />Urinal <br />Drinking Founlain <br />Flo�. drain <br />Grease Irap <br />Roo( drains <br />Other <br />ino'� ��/�� <br />" MECHANICAL <br />NO. I TYPE OF FI%TURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas Iirepiace <br />Gas range <br />Cbthes dryer <br />Range hood <br />Exhaust fan <br />Heal pump <br />Unil healer <br />Boiler <br />� Refngeration <br />Woodslove <br />CITY OF EVERETT LOCAI SALES TAX CODE IS J105 <br />I hereby cerili(y thal I have read and examined this application and know the same to be true and correcL AI� provisions of laws and <br />ordinaces governing this lype ot work will be complied wilh whether speci(ied herein or �ot. The grenting of a permit does nol presume <br />to give aulhorily to violale or cancel lhe provis�on o( any other state or local law regulating constn,clion or the performance of <br />conslruc�ion. Thal I am authorize �by lie owner o( lhis propert� to peAorm the work for which application is made and I compty with Ihe <br />State Ca k to�rs.�aw/� P1.27 R �id 296.200 WAC. <br />, % ��/%t'����,%%i 3 d7- 7 <br />