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SITE ADDRESS <br />u'-i� y',s'=' <br />LEGAL Bif NO. <br />DESC. G�N�'� /��/G <br />OWNER <br />/�OS U '�O <br />TENANTNAME <br />CONTRACTOR ��x <br />CONTR. UCENSE tl <br />Qn.: <br />USE OF BUILDING <br />�• f � <br />WORK DESCRIPTION <br />P�RMIT APPLICATION <br />CITY OF EVERETT PERM!T SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARF CCEPTED FROM B AM TO 4 PM �` � C� �, �� <br />PARCEL TAX I.D. p PERMIT M <br />�o v.7T .S • r J�'o5/B�.3A3 yoo � 7610 -/7�/ �) <br />BLOCK TRACT <br />"? �Nc I/�CG /%%rl.t'�/�E <br />ICONTACT FOR PERMIT <br />iCL�N /SEG/7 A�0 <br />Ni� �Nl• ADDRESS <br />� U�lZG2- <br />�%Pl7 i <br />,4,r� s ✓;//t' <br />�67TfPJ PI <br />" CITY2IP <br />.Si4 M� <br />HEAT SOURCE I <br />Elndric _� as _ Olhor <br />8�,�. -!. sz-7-S9/ <br />3� Gsz - 71 s%/ <br />PHONE <br />CONTRACT PRICE OF WORK <br />/ / � <br />�oiV3r��2Urr.'6N Or _i��vy�f FiQ•vr,�C., .QCiSi�Ori✓<� rfj�ls.0 Z/4� <br />PLUMBING <br />NO. I TVPE OF FI%TURE OR ItEM <br />%— <br />� <br />� <br />I TOilol <br />Dathlub <br />Lavalory (wash Sasin) <br />Showcr <br />Kitchen sink 8 disposnl <br />Dishwasher <br />Clolhes washer <br />Walcr heator <br />Sink, (sorvicolbadmop/r.lc.) <br />Bar.kOow pmvonler <br />Urinal <br />Drinkinc� Founlain <br />Floor Arain <br />Groaso trap <br />Roof drains <br />Olher <br />N0. I TYPE OF FI%TURE OR ITEM <br />A/C - alr hantlling urrts <br />_f Forced air systoms <br />�Gas piping <br />Wator hoa�er <br />Gas lireplaco <br />� Gas rango <br />_, Clothes dryer <br />_�_ Ranpo hood <br />.Y Ezhaust�an <br />.�-- Heal pump <br />Unil hoalar <br />Boilar <br />— Roldgeralion <br />Woodslovo <br />— Olhor <br />CI7Y OF EVERETT LOCAL SALES TA)( CODE IS �705 <br />I nereby corilify Uial I have rcad and examircd Ihis application and know the samo lo be lruo and correcl. All provisions oi laws and <br />orAinar,es �ovorning this type ol work will bo comp�iod wilh whelher spocified horoin or nol Tho granling o( a permi� does nol presume <br />lo give aulhorily tn viola�o or cancel iho provislon o' any olher stato or local law rogulaling consiruclion or lhe peAormance of <br />conslruction. That I am authorizeA by Iho ownor ol;his propeAy to poAorm the work (or which applicalion is made and I comply with Ihe <br />Stato Contraclors Law 1ti.2j�RCW and 29G.200 WAC. <br />KGi/.(%� i( �l�i� G�����'% <br />