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SITE ADDRESS <br />� U r7 L' � <br />LEGA LOT NO. <br />DESC. <br />PERMIT APPLICATION <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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�• � PARCEL TAX I.D. # <br />�7 <br />BLOCK � I TRACT OR SUBDIVISION N <br />/b �-7 /?� <br />c� l0- c=r�� <br />.Ste�,o(��st ��mm�ri�o�l %-l3y3 ✓o� Ya�.�x.n 2rvir�, C�1- C��!`7) SSa-G7oo <br />I�'r'c.n��-l-i ' t 5'F� `3 C>U `l e1 bOC. <br />TENANT NAME CONTACT FOR PERMIT PHONE (H2 j J C6G9 — C)�l(/y <br />�1/�'/� I Shan-e- Tqpc�r+ E-MAILSTqOiv;-1-e r;ir+l�,-[�4 <br />15irtley --C'cL� �4ssvG <br />CONTR. LICENSEH <br />Ksr����+L9si/3c <br />USE OF BUILDING <br />�L�� i � <br />WORK DESCRIPTION <br />l/�n�IIG <br />LG � <br />�UIU SE e✓�refl r1n(1 WA-j: <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathlub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Waler heater <br />Sink (servicelbar/mop/etc.) <br />Back9ow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />HEAT SOURCE <br />_ Electric ,�[, Gas _ Other <br />S h.� � 1 <br />T.�-�pr�v�e.m,�n-�S <br />NO. <br />� . . .. <br />�t�s� 6�y-�y�� <br />evere-Il�, �s'sZo� <br />CONTRACT PRICE OF WORK <br />���,GG� <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust (an <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <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 cortect. :all provisions of laws and <br />ordinances goveming this type of work will be complied wilh whelher specified herein or not. The granting of a permit does not presume <br />lo give authori�y �o violale or cancel the provision o( any other stale or local law regulaling construclion or the performance of <br />consiruction. Thal I am authorized by the owner of lhis property to perform the work forwhich application is made and I comply wilh ihe <br />Slate CoNractorr_ Law 1637 RCW and 296.200 WAC. <br />`-- �� ��� � l0 <br />�/2 <br />