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SITE ADDRESS <br />LOT NO. <br />DESC.� �) <br />P`�RM�"f APPLIC�ITIL �V <br />CITY OF EVERETT F'ERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-25?-8810 — FAX 425-257-8857 — www.everettwa.org <br />, <br />� ��� <br />J' ' 1�� <br /><� <br />APPLICATIONS ARE ACCEPTED FROM S AM TO 4 PiIA <br />PAR�EL TAX I.D. � PERMIT # <br />5' V� ln1 C105 �1UC�oc7 �(�JUU � G�'S- �� <br />BLOCK TRACT OR SUBDIVISION # <br />-;e_�c� S aGl< o00 -cr�-N �,S �r p f- E(IS_�'T p F LoTyy �r [1LA 98-Iv3S� <br />K d- N\ Cci�Str��i-io,�. $dcl 7�(7�` � L (�j � P:�A��V� IIC <br />TENANT NAME CONTACT FOR PERMIT i°�iONE Y,jS- Pi �7U -%.Z �� % <br />�vli�'�i� UC'_C.J1� _ _.._._ E-MAIL _ _ _ <br />wninA�ivn ..,,.,�.�,.., _...._.. ----- <br />Sv��1c{V� zi,.� Cu.�+r<ci-ofS i�-v' (jv� aG�(3 I=UGYff YV.�l�J �/.?S��>7U• ?ZY% <br />CONTR. LICENSE N <br />� U U i�l (J C L�-j $ I I< G� _ <br />USE OF SUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />�� i2 _ Electric ,� Gas __ Olher I ��� 00 G <br />r <br />WORK DESCRIPTION <br />�� <br />NO. I TYPE OF FIXTURE OR ITt�M <br />Toilel � <br />Bathlub <br />Lavatory (wash basin)5 <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />6ackllow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />� 5 v /�ja L� <br />o'�/ � <br />z�x a-a <br />��� D 5 ��- I <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC — air handling uni�s <br />1 Forced air systems <br />� Gas piping <br />I Water heater <br />� Gas fireplace <br />f Gas range <br />� Clothes dryer <br />/ Range hood <br />� Exhaust f�n <br />Heal pump <br />Unit healer <br />Boi�er <br />Retrigeration <br />Woodslove <br />CIN OF EVERETT LOCAL 3ALES TAR CUDE IS 3105 <br />I hereby certify lhat I have read and examined this applicalion and know the same to be true and correcL All provisions of iaws and <br />ordinances goveming lhis type of work will be coroplied wilh whether specified herein or not. ?he granting of a permit doee nol presume <br />lo give authority lo violate or cancel the provision of any other stale or local law regulating c�nstruclion or the pertormance of <br />construction. Thal I am authorized ow �roperty lo perform Ihe work for which application is made and I comply wiBi lhe <br />Stale Contractcrs L� .� .200 WAC. <br />--� � S- 7- z�ra <br />��. <br />Signature of OwnedCon�ractor/Au�horized Agen� Date � <br />�Z <br />