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SITE ADDRESS <br />�u(-,l1 � <br />LEGA LOT NO. <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVIC�S <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.evereriwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. S <br />F\�. On S S �.�003 O�1 C1 <br />BLOCK TRACT OR SUBDINSION � <br />b ,. �.Z —/D <br />PERMIT M <br />N�,�. ��,1e� �- <br />w'U"n��n V�� �,.y IG6�l'jl�,��a�_-� �i�� 1_�ert11 �i�$'.��`� '-�dS-.�1��J.-Jl�.�i <br />TENANTNAME COHTACTFORPERMIT PHONE <br />IFc:k'�<.10�� �I25 -��Il-1�I�`� <br />y E-MNL 1 �oO1J�,�,t.ivl.�qt.1.Ci <br />�n.�om� �7�e��T <br />ADORE55 l' -� �.��nur r�...�.� - <br />�►..,s��.:.,,�.. �1.,j���1 (,�., . �.c �s �., c:.,,� � �+� � -�.—„�<<f+ ��a.,:� <br />CO R.LI�NSE• ��1�5-��I1'I�II�I <br />��"rl,sH Lt16 �,�3I_� <br />USE OF BUILDING HEAT SOURCE COHTRACT PRICE OF WORK <br />I — � , � <br />Electric _ Gas X Olher � y � <br />r <br />WORKDESCRIPTION�`�It.c� �X.y���tiy ��U% qa1 (�t'�.c�ci �.�;\1� ����� �0��. �1'�� '�•Ir�,� <br />J J J <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilel <br />Bathlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/badmupletc.) <br />Backflow prevenler <br />Urinal <br />Drinking Founlain <br />Floor dra�n <br />Greaselrap <br />Roof drains <br />Other <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C – air handling units <br />Forced air syslems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gas range <br />Clathes dryer <br />Rangehood <br />Ezhauslfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 7105 <br />I hereby certify thal I have read and examined this application and know the same lo be true and cortect. All provisions of laws and <br />ordinances goveming this type of work wil� be complied with whether specified herein or not. The granting of a pertnit does not presume <br />to give authority to violale or cancei the provision of any other state or local law regulating conslruclion or lhe peAortnance of <br />construction. That I am authorized by the owner of this property to periorm lhe work for which applicalion is made and I comply with the <br />State Contract-rs Law 8.27-R�W and29b"lD0 WAC. <br />/ i �) <br />t��� `i' ' ��/ �yc' � �' <br />