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SITE ADDRESS <br />OS- � f-�. <br />LEGAL LOT NO. <br />DESC. 3 t'�(I <br />OWNER <br />��/✓) t /� L�Y1 i� l <br />TENANT NAME �� <br />%pM � �J� ] <br />CONTRACTOR t <br />�.L'a r$iwi CJ nS�T <br />CONTR. LICENSE N <br />PERMIT APPLICATI�N <br />CITY OF EVERETT PERlVIIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 9820? <br />425-257-8810 — FAX 425-257-8857 — www.everettvt�a.org <br />,�PPLIGATIONS ARE AC�EPTED FROM 8 AM TO 4 PM <br />�Q Sf. <br />BLOCK <br />', ke <br />PARCEL TAX I.D. It <br />0�5 32 - 3 7- <br />TRACT <br />5}' �G�lC !//'f � <br />ADDRESS <br />S" S�:�e S� fi�� <br />CONTACT FOR PERMIT <br />i //!� KQ <br />ADURESS , <br />10,�0 �K /lrayhf� <br />Lf}�SEG '.JF I�f D <br />USE OF BUILDING I <br />rs <br />3 � vd <br />�io,� <br />0 <br />S�o <br />PHONE <br />yas- 3a�- � s35 <br />CITY2IP PHONE <br />!�n Ever��! 9��8 4�5-3•�7-a.5�5 <br />HEATSOURCE <br />�, Eleclric _ Gas _ Olher <br />WORK DESCRIPTION D /' <br />l�e-�IGCc' -i-ix�Jr[`i Iw �rCG'�Yl <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Cbthes washer <br />Laundry tray <br />Sink (service/badmop/elc.) <br />BackOow preveMer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Greasotrap <br />Roof drains <br />Other <br />CONTRACT PRICE OF WORK <br />���`: DO <br />J <br />NO. I TYPE OF FIXTURE OR �TEM <br />_ A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Waler healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Rangehood <br />= Exhaustfan <br />Hcat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerility Ihat I have read and examined this application and know the same to be true and correcL All provisions o( laws and <br />ordinaces goveming this lype of work will be complied wilh whelher specifed herein or noL The granting of a permit does not presume <br />lo c�ive aulhority to violate or cancel the provision o( any other state or local law regulating construction or the peAormance of <br />construction. That I am authorized by lhe owner of this property ro perform the work for which application is made and I compty with the <br />Slale Contractors La/w /18.27 RCW � �d 296200 WAC. <br />��%%L�4i� ��/.G�.— �.1�..��'OJr <br />