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SITE ADDRESS <br />73a��(��x <br />LEGAL LOTNO. <br />DESC. J�j <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 />APPLI�ATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. N <br />� f o�S'f Y2oo <br />BLOCK TRACTORSUBDIVISIONf <br />¢ �7Y1.V.4rl G <br />�r <br />4ERMIT N <br />�_1 u�5-r�>>3 <br />��D � �E B$ �€ `�a,.t�E S 732r %r✓ �f.' �"V�/t.rl7' �1'�203 <br />TENANT NAME CONTACT FOR PERMIT PHONE �,)�_S��L�, /,� �� <br />• '7C<7.TOA�� �v✓GtveS .5-,qYo.S>z2.E�za�3k0-;TB�s°-9c4F� <br />�ll/N,�� _5=2?�� E�-�`'Y/-9yl•.�Ff� <br />CONTR. LICENSE • � <br />iA /_�/7 — <br />USE OF BUILDING <br />k L-'%•iL>rNC'� <br />i,� <br />HEAT SOURCE I CONTRACT PRICE OF WORK <br />f �c <br />��Eledric '✓Gas Other �'n�,�, C�Y' <br />WORKDESCRIPTIONr���.CLr=U!✓L%/'C/X�C%(��C-�,Sf.�G'!%%'//CYj�.S�/%�`rc ( �Q'�/P.`n'� <br />/aUv /S 3:F' �3AY /lti�n <br />L.�✓: J' ✓� f'oi; c.-a L�iV?r. y $: �A/�7nG : J: c.K <br />N0. I TYPE OF FI%TURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />BackAow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drairs <br />Other . <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas f replace <br />Gasrange <br />Cbthes dryer <br />Range hood <br />Exhausl fan <br />Heat pump <br />Unit heater <br />8oiler <br />Refrigeretion <br />Woodstove <br />CITY OP EYERETT LOCAL SAIES TAX COOE IS 3100 <br />I hereby certify that I have read and examined this application and know the same to bs true and correct. All provisions of laws and <br />ordinances governing this type of work will be complied with whether specified herein or not. The granting of a pertnit does not presume <br />to give authoriry to violate or cancei the provision of any other state or local law regulating construction or lhe performance of <br />construction. That I am authorized by the owner of this property lo perform the work for which application is made and I compty with the <br />Siate Coptraclors Law 1827 RCW and 296200 WAC. <br />� �\l +� f� <br />- ..f,�il`,C��'Lc �T IIGG�C..� 7 ��—.�C���� <br />Signalure o( Owner/C9ntreclor/Authorized Agent Date � <br />/Z- <br />