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, <br />r ,.-.,;� <br />_ <br />{' <br />PE�cMIT APPLICATION <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 />f!r ;� �� l !� Y, i� APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS f C,(�� �C,Za/ <br />��� ��M�� � � � <br />LEGAL LOTNO. BLOCK <br />DESC. <br />OWNER <br />�ol�� � C��r�s��� �•,��=%-ler< <br />TENANTNAME <br />s :"t,� <br />y�l�i!¢l/� ��r�nSFs` Ztic, <br />s <br />CONT LICENSE # �,�1 <br />�IL�G/�/D"I'70� <br />USE OF BUILDING <br />� C � <br />WORK DESCRIPTION �p�!IJ ���LJ� <br />�'lt��(�Wi' tiv�q�6C G�✓�c`' p1ih <br />ro��' �i#�G�.Es w� re <br />�Gyn��E� w� u��-o �h�F <br />PARCEL TAX I.D. # <br />S �i� <br />TRACT <br />ADURESS <br />_ �cS 3��rr� �k <br />CONTACT FO PERI�IT <br />J�l ��e ,�kG�•�r��sev� <br />ADDRESS <br />jc/G�0 lc�i�� S-��JL" <br />HEAT SOURCE <br />G'� <br />_ Eleclric �Gas _ Olher <br />�65'r S�il/�cr'FS W/�� S�FI'n <br />� root�� HreA,�r6�, QNiS <br />v��s��y� re- r�a-F,, rP�� l�ce <br />NO. � TYPE OF FIX7URE OR ITEM <br />Toilel <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink {servicelbadmop/elc.) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />Cr�� S{�'✓e�s <br />� �s� <br />4 -3-0(0 <br />NIT # <br />Si a ` <br />a��fZS �- � <br />PHONE <br />)' i7_!r9 <br />�s s� s� <br />PH NE <br />��ZS� 3 3S' s/3/ <br />i v,-��GO`�G9(--fs�Z <br />CONTRACT PRICE OF WORK <br />FPPM�nq 1n.GII�j �70'�l �. <br />� C/ / � -y <br />qPvlT'�,� DYY�'Cy- �,�'� <br />tl�, c�iv� , rv�/��� � /Fc-�r%�n ( <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handlinc� units <br />Forced airsystems <br />i Gas piping <br />Water healer <br />Gas (ireplace <br />Gas range <br />�Clothes dryer <br />Range hood <br />Exhausl tan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I nereby ceritify that I have read and examined this applicalion and know the same lo be true and correct. All provisions of laws and <br />ordinaces yoverning this type of work will be complied wilh wheth?r specified herein or not. The granling of a permil does not presume <br />to �ive authoriry lo violate or cancel lhe provision of any other s;ace vr local law regulating consWction or lhe pertormance of <br />construclion. That I am authorized by the owner ot lhis property to perform ths work for which epplication is made and I comply wilh the <br />Slate Coniraclora I,aw 18•27 RC�Q a�'d 296200 WAC. � <br />