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SITE ADDRESS <br />- K.o�, <br />LOT NO. <br />23a 24 <br />P�r2MIT APPLIC�►TIOi� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERElT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM <br />�.I k,r �-,rL, <br />BLOC'( <br />7q2 r - o0 <br />PARCEL TAX I.D. # <br />vo � 9 7 z <br />TRACT <br />C ✓eY�'r7' D r ✓, <br />OL3 00 <br />0 <br />� 070� -00� <br />I7 <br />Ri �K ,�L�n1M i� 4• N ox 3�o E�w,oni�s�c�q e'8oao (����3�g� <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />�uDo�n�f Z�c�/k-,4 �2��k Kl�--�n� C�as)7�y- 3r s! <br />CONTRACTOR ADDRESS CITY2IP PHONE <br />�l/oR-r�+ C,�sT Dc-u Ca2P p. o. C�bx 3yo E�A•+�vN�s, wA 5gozo ��fzs) ���-3��� <br />CONTR. LICENSE N�D 2T�iG� �S� D�Q� / Z// //J�T ) <br />USE OF BUILDING <br />flP/1+�'TMEnI T <br />HEAT SOURC� CONTRACT PRICE OF WORK <br />X Eleclric _ Gas _ Olher �8� CJ-�i � <br />WORK DESCRIPTION ���S�uG•r- NE'Gt> <br />�},2A6ES . <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Balhlub •i.l,l,'.- � <br />Lavatory (wash basin� <br />sink <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Groaso trap <br />Roof drains <br />Other <br />�U� Uti�r�r' APr4�TMEn1T w �r�FF <br />NO. I TYPE OF FIXTURE OR ITEM <br />-I A/C - alr hand�ing units <br />Forced air systems <br />Gas piping <br />Water hoater <br />,�I Gas fireplace <br />y,Gasrange <br />fan <br />Boiler <br />Re(rigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />, <br />� ,.i,:!� i.._+��., , 1 <br />I hereby cerili(y thal I have read and examined this application and know the same lo be true and correct. All provisions ol laws and <br />ordinaces c�oveming lhis lype o� work will be complied with wholher specified herein or nol. The granling of a permit does not presume <br />to givu authorily lo violale or cancel lhe provision of any other state or local law regulating construction or the peAortnance of <br />conslruction. Thal I am aulhorized by Iho owner of �his property to perform the work for which application is made and I comply with tho <br />Stale Contraclors Law 18.27 RCW and 296.200 WAC. <br />2'c� i�i.�„ _ _ _ �Z�fJ / Olv <br />