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SITE ADDRESS <br />��l �'OI ��I(c <br />LEGAL LOT NO. <br />DESC. <br />P�RMI'f APPLICATIarI <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98:?01 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPI.ICATIONS ARF ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. ri <br />BLOCK � TRACT OR SUBDIVISION K <br />OWNER AODftEss �nnar rnune �yu�' <br />�LC��r� /7/aC���"t— C.�v^c� :��'DI V/'c�ir7�W N�ic? ���1��.Cc.{{ �J`-9-�os4S <br />TENANT NAME CONTACT FOR PER IT PHONE �•�u-� �j ��.- �73p <br />�/�'i L �' SG5.1 � E-MAIL I�MI — L�J Co.+7�A5i • <br />�GbFiR7t� R r�j �,.J (1 G�' R$$ Z <br />CONTR. LICENSE # <br />USE OF BUILDING <br />G�t� ^c �, <br />WORK DESCRIPTION , '� <br />�c{c� �XT�n�o2 ,iu0�2 <br />��C�Sr-rn4 �ua'.0 ; <br />J <br />HEAT SOURCE <br />� _ Elec�ric _ Gas _ O�her <br />+v J(���-� 5�.��e..5 <br />F'L�r�v�.�y <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />f3alhtu5 <br />Lava�ory (wash basin) <br />Shower <br />Kitclien sink & disposal <br />Dishwasher <br />Clolhes washer <br />Wa�er he�ier <br />Sink (seivice/badmop/etc.) <br />Backtlow preventer <br />Urinal <br />Drinking �oun�ain <br />Floor drain <br />Grease irap <br />Roof drains <br />Olher <br />NO. <br />CONTRACT PRICE OF WORK � <br />0 <br />/L0o � <br />5 ri �a . �7 7 J <br />MECHANICAL <br />TYPE OF FIXTURE OR ITEM <br />NC — air handling units <br />Forced air syslems <br />Gas pipmg <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hooJ <br />Ezhausl fan <br />Heal pump <br />Unit heater <br />Boiler <br />Relrigera�ion <br />Woodslave <br />Other _ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cr,rtify Ihal I have read and examined Ihis aoplicalion and kno�v Ihe same �o be true and correct. All provisions o( laws and <br />ordinances governing ihis lype of work will be complied wilh whether specifed herein or nol. The granting o1 a pertnit does not presume <br />to give authonty lo violale or cancel ihe provision o( any olher slate or local law regulating construdicn or the pertormance ot <br />cons�ruclion. That I am au�horized by Ihe owner of this property �o pertorm Ihe work (or which application is made and I comply wiih ihe <br />State_Gpntractors Law 1827 RCW and 29G200 WAC. <br />�� 3 zoe� <br />'/L <br />