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� <br />SITE AD�RE55 <br />/aS�3 , <br />PERMIT APPLICATION <br />CITY OF E1/ERETT PERMIT SERViCES <br />3200 CEDAR STREET, EVERETT, WA 94201 <br />425-257-8810 - FAX 425-25i -8657 - www.everettvea org <br />G G `! <br />__._/�lv 1 D� - rX,�'" <br />/PE-RMIT it <br />..1� �C�i.�� ' C�CJ< <br />-_ _ _ --- � <br />LEGALl LOT NO. BLOCK TRACT R SUBDIVISION k � / I <br />oescl 6 �� G�l� �'s�-tir Gef F� i <br />OWtJF�i ADDR[SS CITV/7.IP PHONE � <br />i� <br />C��I��J.e�� PD Bcx g7Ud% %i�:�u,-'�°e��!&�'K6 �/zf-7H� �.33 <br />----- -- _ <br />TENAN7 Ah1E CONTACTFORPERMIT pH NE�G-(�G�J�/$O3 <br />�""�/ ' """�N�^'' E-MAILf%R!2✓h'n.i�+N .(ni� I <br />CONTRACTOR � ADDR[SS � CITY�lIP Ptl �NE —� ! <br />�jiheritft Nu�, L�C� Pp ,8�� Z/Z6 hvP�i�/`�FoY/ ZUG-6G9 -/�io�� <br />CONTR. LICENSE++ <br />r �/ " 3 v Di< <br />-�— 'e�-�--------- -- - - ---- _. — - - - ------- I <br />USE OF BUILDING j HEAT SOURCE ' CGNTRAC7 PRICE OF WORK � <br />APPLICATIONS ARE ACCEPTED FROM !3 AM TO A PM <br />PARCEI. TAX �.D. # <br />�'�-�� �� Fw� I--- �i�� y'700DDO G DtI <br />�iNcc� ��tr.'ic; <br />WORK DESCRIPTION <br />�B�S�ftic,/��•x � <br />�. Eleciric _�Gas _ Olhci I <br />n Ll7�s ° J- � <br />��c �3� <br />PLUMBING <br />NO. 7YPE OF FIXTURE OR I7EM <br />� Toilel <br />—� Balhtub <br />i Lavalory pvash 6asin) <br />� Shower <br />/ Kitchen sink 3 disposal <br />_( �ishwasher / <br />�Ciothes washer <br />� . Waler healer <br />Sink (service'oar/mop/elc.) <br />Backllow preventer <br />Urinal <br />Orinking Founiain <br />Flcor drain <br />Grease trzp <br />Root drains <br />Other <br />�,� ye' <br />NO. <br />� <br />� ..-, .' L �'(��.��-c_�cA� <br />� <br />TVFE OF FIXTURE OR ITEPA <br />PJC - eii hondhny u;uU <br />Forcea air syctams <br />Ga5 piping <br />Water heale� <br />Gas frepiac� <br />Gas nnge � <br />Clolhes dryei <br />Range hUod <br />Exhaust fan <br />Heal pump <br />Und heater <br />Bo�ler <br />Refrigeration <br />Woodslove <br />CITY pF EVERETT LOCAL SALES TA% COUE IS 3105 <br />I hereby certi(y that I have read and examined Ihis applicalion ar.d know !he same to be Irue an�l correcL HII provisions of lavrs and <br />ordinances goveminc� this type of work will be complied �vilh whether specified herein or not The granting ol a permit daes not presurne <br />to give authority to violate or cencel ihe provision ol any niher stute or Iocai law rrgulaling consl�ucticn or �he pertormance of <br />consVy§tion. Thal I am authorized by ihe o�vner of ihis Uropeny lo pertorm Ihe �vork lor which applicauon is maoe and I comply vrith tho <br />State/T�4nir�ctojs La�v�j9.27 g6W and 296.200 WAC. <br />.� �� � 20/ D <br />��Z j <br />