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SITE ADDRESS <br />��� 3� <br />LEGAL LOT N0. <br />�oA��sE IT <br />TENANTNAMG <br />� <br />; <br />PERMIT APPLICATIO�i <br />CITY OF EVERETT PERMIT SERVIC�S <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 426-2�7-8857 — v,rNw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �'/; ! <br />� r� �� �� <br />BLOCK <br />L�D�uG^S . L�-�- <br />CONTRACTOR L. (!�, Cp u•> i Ruc'f � U�J <br />s2QV1�iS.Lt,G <br />CONTR. LICENSE ii <br />L.GLD�.IG�. <br />USE OF F3UILDING <br />SFR <br />WORK DESCRIPTION <br />CVtijjll��T /VS,�.., SF�. <br />NO. I TYPE OF FIXTURE OR I7EM <br />Toilel <br />BathWb <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Cbthes washer <br />Walor heater <br />Sink (service/�ar/mop/elc.) <br />Back(low prevenler <br />Urinal <br />Drinking Fountain <br />�!oor drain <br />G�ease trap <br />Roo( drains <br />Other _ <br />PARCEL TAX I.D. # <br />�2$C��-J C> 1 DG�. UO j�0 O <br />TRACT <br />� L�t,� v-�001i G R�STf <br />�c� � co�a�� <br />CONTACT FOR PERMIT <br />�r aYav <br />U l I� c' 0% <br />PERMIT# � <br />� r/�n /� - Cx%�) <br />L/ <br />PHUNE <br />;�I �;��.aus ya5�a�3�S�5Z. <br />ADDRESS v <br />pm(3 y�o�, <br />asa� a��.dw9 y <br />r-. <br />CITYIZIP PHONE <br />+-I�5-�43 -5S',C,L <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />Eleclric �` Gas Olhor � 1 3U�DU U <br />NO. I TYPE OF FIXTURE OR I7EM <br />_I A/C — air handling unils <br />� Forced air systems <br />� Gas piping <br />W aler heater <br />� Gas (ireplace <br />� Gas range <br />i Clolhes dryer <br />� Range hood <br />�_ E,chaust fan <br />Heat p��mp <br />Unit hee:ler <br />=I Ooiler <br />Refrigeration <br />VJoadslove <br />CITY OF EVERETT LOCAL SAIES TAX CODE IS 3105 <br />I hereby ceritify lhat I have read and examined Ihis applicalion and know tho same lo oe true and correcL All provisions o( laws and <br />ordinaces governing this type o( work will bo cumplied with whether speci(ied herein or not. The granting o( a permit doos not presume <br />to give aulhoriry lo violate or cancel the provision of any other state or local law reyulatinc� conslruclion or lhe pedormance o( <br />constmclion. Tlial I am aulhorized by lhe owner of lhis property to per(orm Ihe work (or which application is made and I comply wilh lhe <br />Statc Contractors Law tU.::7 RCW and :96200 WAC. <br />O '3 C� Q (L �/ <br />ate z <br />