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/ %( <br />SITE , <br />�'.�_ <br />7 . �� S� <br />; <br />PE�RMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, E\�ERETT, WA 98.201 <br />425-257-8810 — FAX 425-7.57-8857 — www.everettwa.org <br />.. ,�� <br />; -1 3 `-� <br />LOT N0. <br />lt-1, lo, lk� <br />S�M Pr�auNkvzs <br />APPLICATIONS ARE ACCEPTED FROM 8 AM14 TO 4 PM <br />� <br />�.._ o z-�7 <br />n�.� �•,� - o� 7 <br />PARCELTAXI.D.'IF G�-�%(-�lZl-u�� � n.-.+..�rH �l <br />•�• �� �I a,�{36�t -�Z1-01�1-ec 't C � �i�� —V�J <br />BLOCK P��T a�E ��'k:v�.tT fl���s��ou���,� �3 (� io l <br />�Z, <br />ADDRESS CITY2IP PFIONE.,s.-jS.{. 3 O <br />�S13o-Ft Cp,.�N;ry c.i.�8 Oe. �A�-�-CRFkk. la%a�4iSo�z <br />TENANT NAME <br />tJ �O (�t� <br />CONTRACTOR <br />�3-rn�. Fko�� �F Cc�>; rz =�N L <br />CONTR. LICENSE # <br />5T�2�2 e�qq�l 6�H <br />USE OF BUILDING <br />2�5��,�N��a�. l.N�i,:�, ��•�►y <br />WORK DESCRIPTIbN <br />Co�Szr�;c.r �a� <br />5 �T� wea-i� <br />CONTACT FUR PERMIT PHONE <br />M��� Te��D �2S-?S`(-83 8 n <br />ADDRESS CITY2IP , PHONE <br />Q.0.6o'� t�'39 SI�uo4�r��til, yzs-�S`;-8340 <br />C.:��RGT P�GaF-Seu M�k� TaOD <br />HEATSOURCE <br />� Eleclric _ Gas _ Other <br />CONTRACT PRICE OF WORK <br />� 523� ��a <br />Two icZ., .��� aai�-d�.-�,5 t�u� R�l.�t��� <br />� o�c��dw� l.��sc �� �� <br />3�a�� I Zc�3 <br />NO. T:'PE OF FIXTURE OR ITEM <br />_��j_ Toilet Ill <br />�( Balhtub � <br />1.� . Lavatory (wash basin) �j r <br />�� Sho�ver <br />� , Kitchen sink & disposal <br />•I Dishwasher <br />� � , Clolhes washer <br />_ � Waterliea� <br />_ Sink (servicelb �r�/mop/etc.) <br />_ _ 9ackflow prevenTer� <br />_ _ Uri�al \ <br />_ _ Grinking Fountain � <br />= Floor drain � <br />— Grease lrap <br />Roof drains <br />Other <br />Mt(:HANIGAL <br />TYPE OF FIXTURE OR ITEM <br />FVC — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Range hoo <br />Exhauslfan� � <br />Heat pump \ <br />Unit healer <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have �aad and examined this appiicalion and know the same ro be true and correct. AI� provisions of laws and <br />ordinaces governing lhis type of work will be complied wilh whether speci(ied herein or not. The granting of a permit does not presume <br />lo give aulhority fo violale or cancel the provision of any olher sta'e or local law regulaling consWction or the performance of <br />construction. That I am authorized by the owner of this property to pedorm the work for which applicalion is made and I comply with the <br />Slate Conlraclors L�w-�F�,27 RCW and 296.200 WAC. <br />�2lizl 06 <br />`/� <br />