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I SITE ADDRESS <br />I.EGAI� LOT NO. <br />DESC. z 3 E Zt+ <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 />�2. � �e.� rt'V� <br />BLOCK <br />�2 D- o0 <br />PARCEL TAX I.D. # <br />vo�3�9 �9z oa3 DO <br />TRACT <br />c ✓�/�-r-r' D ! ✓, R� <br />�� <br />lJo�o� <br />uo�o,� <br />1�o7C3 -023 <br />�v v��i.� - oi.i <br />PE/R�MIT iF <br />1/7�n�7'i�i�✓ <br />k'IcK KLGviM �?4• �3ox 3�o EDv�on/�s�G1A�ISoao Ly���Y-3�81 <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />�tuDo�n�f Z�Lcti/K,4 �'«�. �•�� Cvzs)7�y- 3r s � <br />CONTRACTOR ADDRESS CITY2IP PHONE <br />No2-rrt C,�r D�. Ga2P p. o. c�,c 3� e�►�oNJs, w� 5�ozo ��Ls} ���-3�si <br />CONTR. LICENSE # \ <br />^/n 2.r�+c� /5's b4 �1 �/ /Ci�' 1 <br />USE OF BUILDING <br />fIP/7+�'TMEnIT <br />HEAT SOURC� I CONTRACT PRICE OF WORK <br />X Eleclric Gas )thor 3�� CJS/ <br />WORKDESCRIPTION GD/.ISTYl-NGT NELJ �t7�{/2 U��r7- AP�4i2TMEnlT A! �Ti� <br />(SR,2�46ES . <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavatory (wash <br />sink <br />Urinal <br />Drinkinc� Fountain <br />Floor drain <br />Grease Irap <br />Roof drains <br />Olher <br />NO. I TYPE OF F!XTURE OR ITEM <br />A/C — air handling unils <br />Forced air syslems <br />Gas �iping <br />Water heater <br />Gas fireplace <br />Gasrange <br />� othes dry <br />{� Ra el d <br />� Exh t tan <br />Tlnit healC •� � - <br />BOiler <br />Refrigeralion <br />Woodstove <br />Other _ <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />I hereby ceriti(y Ihal 1 have read and examined lhis application and know the same to be true and correcL All provisions of laws and <br />ordinaces governing lhis type of work will be complied with whelhor specified harein or noL The granling of a permit does not presume <br />to give aulhonty to violalo or cancel the provision ot any other slate or local law regulating conslruclion or the performance of <br />construction. Thal I am authorized by tho owner ol this property lo per(orm Ihe �vork (or which application is made and I comply with lhe <br />Slale Conirectors Law 18.27 RCW and 296.200 WAC. , <br />�2/Ff /D�C <br />����5 �� � <br />