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SITE ADDRESS <br />� � i : �; <br />1L LOT NO. <br />F-cRMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STRECT, 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 />FARCEL TAX I.D. # <br />BLOCK � TRACT OR SU6DIVISION N <br />� <br />/—/S %�( I <br />PERMIT p <br />. <br />� ") �(7 'I <br />DESC.r I I _ I <br />OWNER ADDRESS CITYIZIP PHONE`yZs.� I <br />��azo �59-6SY'� <br />�r��.,�-� i., � .�rc'�, 't8oi Vi,s��,�i� �Jc.<�7�+ ( <br />TENANT NAME � CONTACT FOR PERMIT PHONE �yZS) �3S' � 7>' O <br />'".tT�c�C�:. CG..�.NSnC EMAIL PRT- L@ COn�tn<-- N�7 <br />CONTRACTOR ADDR CITYIZIP PHON I <br />CONTR. LICENSE f7 �� �-'..^�� ..-� �' <br />USE OF 6UILDING <br />HEATSOURCE <br />Eledric _ Gas _ Olher <br />WORK DESCRIPTION - . • / <br />f�. /.. , � �,�.. ��,�:r�.�fo.�'i`1 � S'�9��C3 v��h <br />�,� t,��� -,�; ".( c�,.�i�.,,�. Qf„��, t� 50 <br />i r',i r; �,:.,; �;: ,, :. l n 90 e., F�o,ca� S,cic <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />__ BathWt� <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />C;othes washer <br />W.�ter healer <br />Sinr (serviceNadmop/elc.) <br />Backflow preventer <br />Urinai <br />Drinkmg Founlain <br />Floor drain <br />Grease 1•ap <br />Roof drains <br />Other <br />CONTRACT PRICE OF WORK <br />i : .'-� <br />�(<rf�o.�--.�.1 Qn.+,P �Srrs��`s <br />C n,�'i % 1 2 0 �+-� <br />N0. I TYPE OF FIXTURE OR ITEM <br />_ A/C - air handling unils <br />_ Forced air systems <br />Gas piping <br />Water h^atcr <br />Gas lireplace <br />Vas range <br />Clo�h�s dryer <br />Range hood <br />Exhaust fan <br />Heal pump <br />�nil hea�er <br />Boiler <br />Retngeralion <br />Woodstove <br />I <br />CITY OF EVERETT LOCAL SALES TAX CODC IS 3105 <br />I hereby certify Ihat I have read and examined lhis application and know the same lo be lrue and corred. All provisions of laws and <br />ordinances goveming Ihis lype of woik will be complied �vilh �vhether specifed herein or noi. The granting o� u permlt does not presume <br />lo give authonfy to violale or cancel lhe provision o( any olher slate or local law regulating consin�ction or �he pertormance of <br />constiuclion. That I am authorized by the owner of this property lo periorm �he work lor �vhich application is made and I c.mply with lhe <br />Stale ConUaclors I_aw 1827 RCW and 296200 WAC. <br />. .� . _ . i;'r�i1� f�7 <br />Signalure ol Owner/ContracbrlAuthorized Agenl Date <br />