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SITE ADDRESS <br />(03�4 Pake�e <br />L[GAL LOT NO. <br />oES�. a 3 <br />� <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STAEET, EVERETT,1.'A 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROR7 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />le� pve SC �e�t,R o��195 o���a�3oo <br />BLOCK TRACT OR SUBDIVISION # <br />On (P 3'� D � oOJ <br />�� ������� <br />TENANT NAME <br />1�i �/� <br />a5o� ICeS=tn �y� �,\� <br />�v <br />CONTACT FOR PERMIT <br />��nS Ci f1��0 <br />7- 2�9 --�� <br />FR�o��-lJ <br />�le��h`3�s8 �ao��,a�al <br />PHONE �(j(o , 4, (n� � � �3 <br />CONTRACTOR AOUHt55 uniur rnvnc � <br />Cti�;s C,�;Ib_5�N«re5 �.�C ���a i3a'��,�c. t�'r- W�1',nv�ll�. ao� c�c��,5�1i3 <br />CONTR. LICENSE R SYIATF N����T � ��'�'�' <br />USE OF BUILDING <br />J I �' <br />HEATSOURCE <br />�6lectric__Gas._ Other <br />CONTflACT PRICE OF WORK <br />`�p , o�'�o . o� <br />WORK DESCRIPTION ` <br />p�t'.c ��e /&cX'��,� �S S'�o5 P-e�-ci c,r� �w� W'i1�,o,t�,� c� (�-m' <br />PsYv,w:� o�n�c . AF��o cem�l�c� ��n�tairs R�� o�i Con�'1c.c� �o � <br />,�'i S � � <br />NO. I TVPE OF FI%TURE OR ITE61 <br />Toilcl <br />8alhtub <br />Lava�ory (wash basin) <br />Shower <br />Kitchen sink & d�sposal <br />Dish�vasher <br />Clolhes washer <br />Watcr I�oa�er <br />Sink (scrvice�bnrlmoplMc.) <br />Backllow preventer <br />Urinal <br />Drinking Pountain <br />Floor drain <br />Grcase irap <br />Roof drains <br />Olficr <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air syslems <br />Ga� piping <br />Water heater <br />Gas tireplace <br />Gas rangc <br />Clothes dryer <br />Range hood <br />[zhaust lan <br />Heal pump <br />Unit hcatcr <br />Boilcr <br />Refrigeralion <br />Woodslove <br />Olher- _-_ - _ - _ _ -- <br />C�TY OF EVERETT LOCAL SALES TA7C CODE IS 3105 <br />I hcreby ceritify lha� I have read and exainined Ihis application and know Ihe same lo be Irue and correcL NI provisions of laws and <br />oidinaces governing Ihis lype ol work will be coinplied with whether specilied herein or nol. The t�ran�ing of a permit does not presume <br />� lo give authorily lo viola�e or cancel Ihe provision ol any o�l•,er sta�e or local law regulating eonslmction or the pertormance ol <br />� contlruclion. iat I am ai ihorized b Ihe owner of Ihis property lo peilorm ihe work lor which applicalion is made and I comply wilh the <br />� Slatc Cont ir�rs Lmv 1 27, RCW � 29G200 WAC. � <br />I � Q <br />I' SignaWre o vnenCantractor u'horrzed Agen� �Dat� <br />II� <br />� - --- �- --- —�--- — <br />