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PERM� 9� APPLICATION <br />CITY OF EVERETT PERMIT SERyICES <br />3200 CEDAR STREET, EVERETf, WA 98201 <br />425-257-8810 - FAX 425-?.57-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />LOT N0. � BLOCK <br />IGIfaL E�ST CN1KX-�2iSr' <br />TENANT NAME <br />IpARCEL TAX I.D. # — <br />s3s4voroi9o, <br />TRACT OR SUBDIVISION # <br />DuViA %�AisK �/V3 <br />ADDRESS CITY/ZIP <br />.0 .n2 Q�aECi . si <br />�„ � �a �,oN�s 48 <br />CONTACT FOR PERMIT PHONE <br />i'ficN�ae�. ��tA�rr1 M�,�r-��,..a <br />E-MAIL <br />nuunc. <br />Ce�r:�zcicno�.1, /�/a 'Ao <br />LICENSE # <br />�_ ...�,.^Qa�, _TT <br />USE OF BUILDING <br />s,�z <br />WO: DESCRIPTION <br />3ote 3oz� <br />HEAT SOURCE <br />�.i� ��ur <br />DJ✓A�c %�% <br />Z: Electric ,_ Gas _ Other <br />, �,��f - B <br />PERMIT # <br />� ,,� �p —L��r <br />HONEZp�. ¢�, � <br />�•8�4•�d�3 <br />my�m.rsr, cc., <br />�b•&9 ��3 <br />CONTRACT PRICE OF woKK <br />� /��, zav- <br />/VEG..� �oo.� �2A-Mr-1� L�ET�Ac�%�l± �yK�/� <br />N0. I TYPE OP FIXTURE OR ITEM <br />4 Toilet <br />� Bathtub <br />Lavatory (wash 6asin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />�Clothes washer <br />Water heater <br />� Sink (servicelbar/mop/etc.) <br />Backtlow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease �rap <br />Rooi drains <br />Olher <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air syslems <br />Gas piping <br />Water heater ao�Nl <br />Gas firepiace P <br />Gasrange ���A�` <br />Clothes dryer <br />Range hood <br />Exhausl fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify ihat I have read and examined this application and know the same to be true and correcl. All provisions of laws and <br />ordinances governing this type ot work will be complied with whelher specified herein or nol. The granting of a permit does not presume <br />to give authority lo viola�e or cancel the provision of any other state or local law regulating construclion or the performance ot <br />constructio . T t I am authorized y the owner of ihis property to periorm ihe work tor which appiication is made and I compty wilh the <br />State Contrac Js Law 18•� �nd 296200 WAC. <br />� /O •/3'/c� <br />w. (.� � t� <br />Signature of OwnedContreclor/Author¢ed Agent Date <br />