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SITE ADDRESS <br />LOT NO. <br />oesc. <br />PtRMIT RPPL.ICATIGN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDACt STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL 1 AY, I.D. # <br />TRACT OR SUBDIVISION p <br />PEj2MIT # <br />0 0 �-- 90� - � <br />(4�:i�ZS Z-�S9 � <br />CITY/ZIP PHONE <br />��NN� SC,HRRP//�!C> '�(17 l'�Vl/=G.1 ��Clu�Fuh�rr W��, `7�'"•'_71 <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />����i35`�_ �s Y� ���UE- A�42`iE <br />CONTRA R�.i/�,�U� C,�J��y.`�ADDRESS M ITY21P P ON <br />� 79y�2c,_C�,nl�.��AR;S���� lVz,>�351-1�y; <br />CONTR.UCENSEN �✓�_LU�� I 2 / G(�,) ���1 '�� <br />Il <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WOHtc <br />- � �Eledric _Gas_Othcr y� � 3�t �nG , <br />/ <br />WORK DESCRIPTION <br />/k+�t�l'i�oi�( i G h(Or,�G 1, 3 Z3 �� F�. L�vl��� /1YLGJ� <br />y 3 I s� 1- T. -ro ���L'�a �>r� _ <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilel <br />�alhtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Uishwasher <br />Clolhes washer <br />\Nater healer <br />r i <br />Sink (service/bar/moplelc.) '�� ' �' � <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />F!oor drain <br />Grease trap <br />Rool drains <br />Olher <br />NO. � TYPE OF FIXTURE OR ITEM <br />� A/C - air handling unils <br />/�` Forced air syslems <br />Gas pipinc� <br />� Waler heater <br />Gas fireplace <br />Gas ranc�e <br />_% Clothes dryer <br />Range hood <br />" Exhaust (an <br />� Heat pump <br />Unit heater <br />Boiler <br />Refrigerelion <br />Woodstove <br />Other <br />CIN OF EVERETT LOCAL SALES TAJ( CODE IS 7105 <br />I P�ereby cerilify thal I have read and examined Ihis application and kno�v lhe sam� to be true and correcl. All provisions of laws anA <br />ordmaces governing thi; rype of work will be complied wilh whether specified herein or noL The graniin� •f a permit dues not presume <br />to g�ve authority to violate or cancel the provision of any olher slale or local la�v regulating construction r the per(orma�ice of <br />wnsirur,tion. That I am aulhorized by lhe owner o( lhis property lo perform the work for which applicatic�i is made and I comply with ihe <br />S�ate ConUaclors Law 1827 RCW and 296.200 WpC. / • <br />/ <br />f-, �-�,r�_� G G: `� <br />Signalur- e o�dwnedContr2ctedAulhorized Ac�enl �5 Dale �/ <br />Z <br />