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P�RMIT APPLICATlC,N <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 />!o- ib..ob <br />_�2v =} r� � � _ �5 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 3 CREDR CARDS ARE NOT ,�CCEPTED <br />SITE A�DRESS <br />31Z5 �I�E�F`U.(%«z-NVE <br />LEGA LOTNO. BLOCK <br />DESC. IO • ��. �2 `�/Z� <br />PARCEL TAX I.D. �1 <br />0043�1�j 23c(c.v <br />rn�,c7 <br />)G �0� <br />J�rt t=��uE 1�19 20'�� sr se Gv�aetr w.+. 9Y�2os 'F25 508 2552 <br />if.:IANT NAME CONTACT FOR PERMR PHONE <br />�ta DKc4 � = <br />C.6Jo�T'Oy�� L�eGNtT6L—CS �"L� �jl`� 'P>�l�j <br />CONTRACTOR ADDRESS CRY21P PHONE <br />1';eEe�[���r't c.ot+sTR-v�ztor+ 6ROUP (NG, 12014 20t�STS��L'�tt g82o5 'l'LSS� <br />CONTR. UCENSE • 'L�S`L <br />1'' R-�C'� �G 6 I �-1 1'l i� <br />USE OF BUILDING <br />r�,scc�r co�� <br />HEATSOURCE <br />Elsctric �� Gas _ Olher <br />CONTRACT PRICE OF WORK <br />•s• <br />WORK DESCRIPTION <br />SlN6l�ir ��S-tl�rkG� a1�4 le3 ��-�E - NEw C{��vs>r¢vGTlori <br />NO. I TYPE OF flX7URE OR fTEM <br />Toilet / %/ <br />Bathtub / <br />Lavalory (wash basin) � }� / <br />Shower <br />Kitchen sink & disposal <br />DishwasAer <br />Clolhes washor <br />Laundry lray <br />Sink (service/bar/mop/elc.) <br />�ackflow prevonter <br />Urinal <br />Drinking Fountaln <br />Floor dreln <br />Grease trap <br />Roof drains <br />Olher <br />� <br />' 1 �:'''n _k�{{_ ;� <br />L'i�l <br />TYPE OF FIXTVRE OR REM <br />A/C — air handling uNts <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Cbthes dryer <br />Range hood <br />E�aust fan �� � <br />Heat pump <br />UMt heater <br />Boiler <br />Refiiperatbn <br />wcwasrove <br />OM�er <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS J105 <br />I horeby ceritify thai I have read and examined this applicatlon and know the same to be We and cortect. All provisbns of laws and <br />ordinaces govemir�g this hpe o( work will be complled with whefher specHfed herein or not The granting of e permit does rat presume <br />to givo authoriry to violate or cancel the provision of any other state or bcal law reguladng constructlon or the perfortnance of <br />construclion. That I am aulhorized by the owner oi thls p�operty to pertortn the work for which applk:aHon Is made and I mmply witli the <br />Stata Co»lrB"�cn�s ��d 18.27 RCW and 296200 WAC. <br />I�i•.�,p5 <br />'�Z <br />