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SITE ADDRESS <br />� � -2 <br />LEGAL LOT NO. <br />P�RMIT APPLICATIUN <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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />.:�c, ,.,,n fT.:L- <br />BLOCK TRACT <br />PARCEL TAX I.D. # <br />�2-06 -06 <br />i� �-�i .. � P S <br />�i �, 1lo�Lusc� `� � 7�2 Sp�..l� A✓E �,r��lcil %c�'7o� <br />TENANTNAME I CONTACTFORPERMIT PHONE <br />'�.�,�� ��^��S -z�c `3Eti-ot��G <br />CONTRACTOR � ADDRESS � i_ CITY2IP PHONE <br />�)C. � L.LL. -�Jv�S Sr.R��_xJ T-��Lnc�..F�9u"ot� <br />CONTR. LICENSE # � .J tij C <br />�X �, o. � 5 I� C <br />USE OF BUILDING <br />7 c S S; r- <br />f <br />WORK DESCRIPTIOI� <br />f-i Tt rt.=^, <br />i s�..�—� <br />� c.- T-r ��� I <br />�2 L�-., r •7 � L <br />� ..�_i+-, �ti <br />N0. I TYP[ O� fIXTURE OR ITEM <br />Toilet <br />BathWb <br />Lavatory (wash basin) <br />Shower <br />� Kitchen sin.. & disposal <br />Dishwasher <br />Clothes washcr <br />Water healer <br />Sink (servicelbar/moplelc.) <br />Backllow prevenler <br />Urinal <br />Drinking Fountain <br />Fleor drain <br />Grease lrap <br />Root drains <br />Olher <br />HEATSOURCE <br />_ Electric k Gas _ Olher <br />Z p0 <br />A DO <br />COIJTRAG7 YKIGt ur rrvrtn <br />��/L-. %"O ...� <br />o .�-� c= ': � ^' ` g'- <br />Cu.�'.] � ! NC ib <br />L.XisTrr"� <br />Sa:�'� <br />NO. I TYPE Of FIXTURE OR ITEM <br />A/C — air handling uni(s <br />Forced air syslems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />�, Gas rznge <br />Clolhes dryer <br />t}� Range hood <br />[xhausl (an <br />Healpump <br />Unit heater <br />Boiler <br />Refrigeration <br />VJoodstove <br />CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerili(y thal I h2ve read and examined this application and know lhe same lo be irue and correcl PII provisions o( laws and <br />ordinaces goveming lhis type o( work will be complied with whelher specifed herein or nol The granting of a permil does nol presume <br />to c�ive authorily lo violale or cancel Ihe provision of any other slate or local law ragulating wnslruction or the perfortnance o( <br />construction. That I am aulhorized by lhe owner of this property to pedorm the work for which applicalion is made and I comply with ihe <br />S�at? Contradors Law 1827 RCW and 296.200 N'AC. <br />��. �.1�� / z �G /G <br />� '� Date � <br />SignaW�e of wnedContraclodAulhonzed Agent \I <br />