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SITE AODRESS <br />� �zo <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />i P�fG/. S <br />N RA TOR <br />P�RMIT APPLICATIC�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETf, WA 96201 <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 />MCR� ;i�5�1 (pOC-�G'D.3��/� <br />BLOCK TRACT OR SUBOIVISION p <br />CONTR. LICENSE # <br />i � f) /�,�/.� <br />USE OF BUILDING <br />?� rc? � .��i <br />WORK DESCRIPTION <br />Re �..s a� �c oh G-�'r�-w- � Q- <br />fZ oe i� h i�'G%iS <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />DathWb <br />Levalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Water healer <br />Sink (servicelbadmop/etc.) <br />6ackflow preventer <br />U:inal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roo( drains <br />Olher _ <br />We�mq26 <br />CONTACT FOR PERMIT <br />HEATSOURCE <br />A( (��G <br />Eleclric _ Gas _ Other <br />�❑ <br />9810� <br />r.wn C��� 35359 <br />PHONE <br />E�MAIL �'S ��� s � <br />H <br />CONTRACT PRICE OF WORK <br />/' J� -- <br />�� <br />`�7�cv a%-���� C'L° o�- o95'`i <br />110. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced 2ir syslems <br />Gas piping <br />Wa�er healer <br />Gas fireplace <br />Gas range <br />Cbthes dryer <br />Range hood <br />Exhaust tan <br />Heat pump <br />Unil healer <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />1 hereby ceritify thal I have read and examined lhis application and kno�v the same to be true and correcl. All provisions of laws and <br />ordinaces governing Ihis rype of work will be complied witt whether sper.itied herein or noL 1"he granting ol a permit does not presume <br />lo give authoriry lo violate or cancel lhe provision of any o�, ��r stale or local law regulating construction or the performance of <br />consiruction. That I am authorized by Ihe owner o( this property to perform the work for which applicalion is made and I cumply with the <br />Slale ContraUors Law 1827 RGW and 29620J WAC. <br />� -�,�.�-�%-- �//7�C�' <br />�; " �� <br />Sir�naWr� Ownerl � lFacbr/Auth nzeA Agent Da e '/� <br />