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ii3; ll/2�10 16:41 20693221d0 ARI5T0 IdFCH PAGE OL'l72 <br />PERI4�IT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STR[L=T, EVERETT, WA 98201 <br />425-257-F3810 — FAX 425-257-8857 — wtiv�v.everetriva.org <br />APPLICATIONS AKL= qCC[PTEp FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />�. <br />i r� I l, <br />LEGAL LOTNO. .OLOCK <br />PARCEL Tl�X I.D, H <br />TRAGT Oft SUeDIVI510N rt <br />�uc�� ����a�� ; lvP�13 i�hti t�LW C�m�c�- <br />fEHANT NAME � CONTACT FUR FEfiM1T PHONE <br />3-�i-ro <br />PERMIT if <br />' E-MNL <br />CONTIL�C70R n/� �n.� ADURE59 ,..�!, I PHON[ <br />T11�1rJ%(j lri:G�/iN�Cnl �V ?C`1Z Jrv! �%iif�- SKf Jte:a i1 C <br />CONTR. LIC[NSE p <br />d� W� IFi;/(� <br />�R75TAV1 G � � 6 r�G- /�o./�/�ai 2�o-soi-zz.�b <br />USE OF BUILDING I FIEAT SOURCE � I CONTRACT PRICE- OF WORK <br />S <br />` eteqnc �Gas _. Other <br />WORK DESCRIPTION <br />r e /�1�� ('c.� �/�� — -e � � ti �-g.c <br />�U�%z- p/�MRsec{ Q��LJ +��!'/t <br />rvo. I 7yp8 oF FlX7URE OR IT[M <br />� <br />Toilet <br />Balhtub <br />LavatOry (wash basin) <br />Shower <br />Ki�chen sink d dispo501 <br />Oishwasher <br />Clothes washer <br />Wafer heater <br />Sink (scrvico/badmop/elc.) <br />6acktlow preventer <br />unnal <br />�nnkin9 Fountain <br />Roor drain <br />Graaso trop <br />Roof drains <br />Other <br />5 CGC'/ <br />SG...-, .e <br />NO. � TYPE !1F FIXTURE pR IT[M <br />A/G – art hantllin9 unil5 <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas treplace <br />Gas renge <br />Clothes dryer <br />Fange hood <br />Exhauetfan <br />Heatpump <br />Unit heater <br />Roiler <br />Re/rigeration <br />woodstove <br />CITY OF EVERGTT LOCAL SAL@S TAX COOE IS 9105 <br />I hareby certiry lhat I have reod and examined this application and know the same to be true and correct. AII provisions cf faws and <br />ortlinances goveming this typc af work will 6e complied wilh whether specified herein or not. The graniing of a permit does not presume <br />lo give aulhoiity lo �iolate or cancel the provision of any olhef 5tate or local law repulating cpnStiuClion or the performance of <br />construction, That I am aUtho�ized by Uie owner pf Ihis property IO pedorm the vrork fo� tvhich appticatian is madC antl I comply H�ith the <br />Sl�te Contr��r-tora Law 182? RCW and 2�J6.200 WAC. <br />Yr// <br />m���-� �3 <br />