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SITE ADDRE33 <br />.:.f jU - �n ;r1 <br />LEGA LOT NO. <br />DESC. <br />OYYNER <br />�1��s�.h I�o.� <br />TENANTNAME <br />j��4K.i✓: P /7'C�i'✓7rS <br />CONTR. LICENSE # <br />USE OF BUILDING <br />�� \ \ <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREEI , EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-88° 7— www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />;�� 2�'Og3�� <br />BLOCK TRACT OR SUBDIVISION M <br />� ... �� - - - <br />WORK DESCRIPTION <br />� / � <br />/Y�oJ n.�5 ; u c�� d rl <br />NO. I�� TYPE OF FIXTURE OR ITEM <br />Toilet ��� <br />Bathtubl � In' <br />Lavatory (wash��a�in)� � � � � <br />Shower i <br />Kitchen sink & disposal � <br />Dishwasher <br />Clothes washer� <br />Water heater <br />Sink (service/bar/mop/etcJ <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />l�C' _ �'o t�,� <br />CONTACT FOR PERMIT <br />PD B��aC v1��7 (� <br />HEATSOURCE <br />� <br />_ Eleciric � Gas _ Other <br />`� <br />PNONE <br />�� _���-r� <br />�lt�1n �� n �� <br />P MIT # <br />� % � <br />� ��n � <br />PHONE <br />yas-��+ a-A�`i <br />�c ,�j0& � ._ <br />y.�.'s-�� ys�-"ss'7' <br />CONTRACT PRICE c7F WORK <br />�� �0 OpG� <br />7, /lv4 <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems ; <br />Gas piping <br />Waler heater t <br />Gas fireplace 1 <br />Gas range <br />Clothes dryer t <br />Range hood <br />Exhaust fan � � 1 � � <br />Heat pump <br />Unit heater <br />Boiler <br />Reirigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE !S 7105 <br />I hereby certify that I have read and examined this appiication and know lhe same to be true and corred. All provisions of laws and <br />ordinances governing ihis type of work will be complied with whelher specified herein or not. The granting of a pertnit does not presume <br />lo give authorily to violate or cancei the provision o( any other stale or Iocal law regulating consiruclion or ihe performance of <br />construction. That I am authorized by ihe owner of this property to peRorm the work for which application is made and I comply with ihe <br />State Coniractors a 1.?]�CW and 296200 WAC. � <br />,�y„` �� �� '('y�� / 0�9 /O <br />Signature of OwnedContracbdAuthorized Agent ' Date / <br />��L <br />