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SITE ADDRESS <br />LOT NO. <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SEI�VICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-£857 — vwvw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />/ Z.3.2 3o s�t <br />BLOCK <br />PARCEL TAX I.D. # <br />� oo�loz000c <br />TRACT Ok 5UBDIVISION # <br /># <br />OWNER -- ADDRESS �Z3� 50 5-r-s��,.���r rnvnt <br />��-los � J Ud Y�i� Ev e�r�-ti� l.c)� <br />TENANT NAME CONTACT FGR PERMIT � PMONE �/ �7 �p <br />I IC� UCIDYJS CON �VGt�OY E-MAIL �L� L' a J`a� <br />Iow.G��lulos Co�si-v <br />CONTR. LICENSE 8 TQM � FC�E Ci I SGS <br />USE OF BUILDING <br />5"i u,�j e-t-'a ��� i I y <br />,3iz� t5�*�s <br />HEATSOURCE <br />_ Electric � Gas _ Other <br />L(ZS Z10 390� <br />od u/A- 98�z� z <br />'RACT PRICE OF WORK <br />WORK DESCRIPTION 'I vl S( Q � I Vl CGV t/�C IC a QLk� w p y Y�G( C C�lOul vt S�G� Y S <br />("j4�1� �� eUi Zk�n Lvu (� � ,; G�au� c1t� ,5'T-a��� �ltl' au� �Giv � `ecal�caN <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />� <br />:�PI�'"�� � <br />c�°`� �}e� <br />NO. I TYPE OF FIXTURE OR ITEM <br />I A/C-airhandling units <br />Forced air sysleins <br />' Gas piping <br />Water heater <br />Gas fireplace <br />I Gasrange <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Ref•igeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined this application and know lhe same to be irue and correct. All provisions of laws and <br />ordinances governing this lype of work will be complied with whether specifled herein or not. The granting oi a permit does not presume <br />to give authority to violate or cancel lhe provision of any other slate or local law regulating wnstruction or the performance of <br />consiruction. That I am authorized by the owner of this property to perform the work for which appiication is made and I comply with ihe <br />Siate Contractors Law 18,27 RCW and 296.200 WAC. <br />lC. c <br />Q <br />�%i <br />