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SITE ADDRESS <br />8 �-1 z8 " <br />t EGAL LOT N0. <br />�[SC <br />P�tMIT APPLIC�►T1CC�11 <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 />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br />PARCEL TAX I.D. # <br />S��Lvn�ts__o 0 0 � <br />BLOCK TRACT OR SUBDIVISION p <br />PERMIT # <br />u i��o- <br />CITYIZIP PHONE <br />4tT•'7j7_ <yZ�y�j <br />���� i%�]— ��iZi�-9.' `' f� �,c s 2 t,rV t t� w n 9a za$� _ <br />TENANTNAME I CONTACTFORPERMIT PHONE'3Lp.S6$•D��Z <br />I u 5Cl 1�4 �vnG E-MAII <br />CONTRACTOH v ADUNE55 � CITY/ZTP PHONE <br />F—fLI.-Mc�+ �"44.c+tn '3[vO�S68'O�Ce <br />5 4'oZs w..v.e�ao•.� ��K-c 0�. 2 <br />CONTR.LIC[NS[x ICF4L�-� N "<oolGP <br />KA�.^,c �+�oC�G�P �ovw_.�isti.LJA S�29o_ <br />USE GF BUILDING <br />HEATSOURCE <br />_ Elecinc ✓Gas ___ Other <br />WORKDESCRIPTION �P—�h��v[.d '� '70 <br />�.� S �.-c l\ c. CI S`l o � vi..CJLLc./� <br />- - — --- PLUMBING -- <br />NO. I TYPE OF FIXTUftE OR IT1=M <br />_I ICd@t — - — <br />� 3alhiub <br />Lavalory (wash 6asln) <br />Shower <br />Kdchen sink & disposal <br />Dishwasher <br />Clothes rrasher <br />-- Watcn c�atei <br />Sink (scrvire�badmopletc ) <br />E3ackflow ptevenler <br />Unna� <br />Drinking Fountain <br />Floor drain <br />Greasc trap <br />Roof dra�ns <br />Othei —_ <br />J ��-�G.Gr`1� <br />CONTRACT PRICE UF WORK <br />� oJ <br />5, %Oo _ <br />SCS �Yv.GCQ �`^V <br />5-+-�„- d� d �4 ��.., 5 ce <br />MECHANICAL <br />NU. I TYPE OF FIXTURE CR ITEM <br />A1C - �n nandhrg unds <br />Foiced airsyslems <br />Gas p�piny <br />Water heater <br />Gas liieplace <br />Gas renge <br />Cloihes dryor <br />Range hood <br />Exhaust (an <br />Heat pump <br />Un.l healer <br />3oder <br />Rringeration <br />Woodstuve <br />Other <br />CITY OF [VERFTT LOCAL SALES TAX CODE IS 7105 <br />I hereby ceruly ihat I have read and exam�ned this apphcalion and know Ihe same to he true and correct All pwvisions ol laws and <br />ordinances goveming th�s lype of work �vill be comphed vnlh vihelher spec�fied herein or nol The gran�iny of a permd does not presume <br />lo give aulhorny to wolate or cancel the prov�sion ul any other slale or local law re9ulating conslrurtion or the performance of <br />construclion That I am aulhonzed by lhe owner of Ihis property ro perform Ihe work for which app���cauon is made and I comply vnth the <br />S�ate Conlraclors Lavr 18 27 RCW a�d 296 200 WAC <br />. I� <br />;�a [ a � � 6 ' 7 ' ( � <br />Siynature o( Ownerl ontractod�\i thorired Ageni Date <br />c:i� C.,-utr� ��,:-.r�s L•c.�., �03z3o��- <br />__ . _ :£ - <br />