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IT A�PLICATION <br />CITY AF EVERET'T PERMIT SERVICES <br />3200 CEDAR STREET, EV�RETT, WA 98201 <br />425-257-88 i 0- FAX 425-257-8857 - wwv✓.everettwa.org <br />APPLICAI'IONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS A <br />Ua`�-9 n X 2 /'ct'. <br />LOT NO. I BLOCK <br />PARCEL TAX I.D. p <br />On 5 7/7 (�Da <br />TRACT CR SUBDIVISION # <br />5h02r� AG¢r�.5 Al�A B/��c.k_ <br />r� <br />� --6 —o� <br />vrrn�nG�u� � puunea:s n �i�tiur rnvnry�s <br />D`wA, �/SQo 33��gvE tJ � a <br />rn � c.t �x�u, � �8�a a a �� -o , �t <br />TENANT NAME CONTACf FOR PERM IT PHONE [/�s aVS(—/�'� �.7 <br />PAuio LAabE <br />E•MAIL RLM F�ltG?/VS � <br />2uvl <br />CONTR. LICENSE # <br />"s • �l qvSV BOff� sTIUE <br />�%'�y�v://� <br />7J /� %l% <br />�/FS'.�YY�r.��: <br />Fvu ,�a -(�f�i'-o9'03 <br />USE OF BUILDING ,�/,, HEAT � OUORC � CONTRACT PRICE OF WORK <br />A.l ��,v � I _ � , ,�_� c�/ <br />/[�SI�GKG Eieclric � Gas _ other 70� DO o— <br />WORK DESCRIPTION � g��r #�� 1�1C% M�•- aKo� •���t �U� • M�W ,� 9Q �. <br />,t�oxq . WuT rt �Jc�t, 5�ruy o� 6w� /Ia�Mo f T�pk�wJ iH¢e • sr FI-sT FiooxT � 6� <br />//,-,�,_ w� �r��s Drvti �o �1"i _ f.� l�ra-u'.efT N,c cosax�r, ��/ T�,sG woua, <br />N0. I .\la-� TYPE OF FIXTURE OR ITEM <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Cblhes washer <br />Waler healer <br />Sink (service/bar/mop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roo( drains <br />Olher <br />MEGNANIGAL <br />NO. �PE OF FIXTURE OR ITEM <br />_ A/C – ai handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas tireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heal pump <br />Unit heater <br />Doilcr <br />Refrigerati�n <br />Woodstove <br />Other <br />CITY nF EyERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerili(y �hat I have read ac:i examined this applicalion and know the same to be �rue and cortect. All provisions oi laws and <br />ordinaces governing Ihis type of work will be complied with whelher specified herein or not. The granting of a permil does nol presume <br />to give nty to violate or caucel the provision o�ny olher stale or local law regulating conslruclion or the peAormance o( <br />conslr ction That I am aulhorized by the owner of is property to perfonn Ihe work for which application is made and I comply with the <br />Slal Contr c1or,�aN� 18.2ZfiCW ap(1296.200 WX�C. <br />l�� <br />