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SITE ADDRESS <br />GoB 5 "� <br />LEGAL UYFNO. <br />DESC. �fNi/ �/i <br />P�RMIT APPLICATION <br />CITY OF EVERETT PEIRMIT SERVICES <br />3200 CEDAR STREET, EVFRETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM '7 � � g� Q'� <br />/l PARCEL TAX I.D. p pERM1T p <br />(. o u.rr .5. [� 2f�c.'S'�Ec�o s n,g S�4o �!�../� ' ��o l CI <br />BLOCK —� TRACT <br />Kvsr —f�n�>Gs �rr, //7oG /l��,r;N�D.�•. <br />TENANT NAME CONTACT FOR PERMIT <br />I /��G-•� TEo.f p/o <br />CONTRACTOR ��„ i/_H/�/ /Kf• ADDRESS SµI�.rC <br />/T'G' <br />CONTR. LICENSE p �7� <br />/c[�SU �i• .Z� � <br />USE OF BUILDING I <br />.S. /- ,E' <br />WORK DESCRIPTION <br />HEATSOURCE <br />Elociric �s Olhor <br />-------- I�,ii.7/ --�-�— <br />yS✓�/�F 3Ga-Gs2-7:s9� <br />PNONE <br />sET,-��s a��-�S�-��y. <br />CITY2IP PHONE <br />CONTRACT PRICE OF WORK <br />Lc+NsrRucri'o�v c� .I;i.,q/E �AM�'LY lZEs;Ut��v<B �Bi+s.c��2.22.) <br />NO. I TYPE OF fll(TURE OR ITEM <br />3 Toilot <br />2 Bathtub <br />_� Lavalory (wash basin) <br />�_ Shower <br />_/ Kitchen sink 8 disposal <br />_L Dishwasher <br />�_ Clothes washnr <br />1_ Walon c�alr.r <br />� Sink (sorvir.c/bar/mop/cic.) <br />�ack0ow preventer <br />� Urinal <br />— Drinkinc� Fountain <br />— Floor drain <br />— Greaso trap <br />� Rool drains <br />•— Olhcr <br />N0. I TYPE OF FI%TURE OR ITEM <br />� WC — alr handling units <br />� Forced air s; slems <br />_� Gas piping <br />� Wator hoater <br />— Gas fireplace <br />� Gas rango <br />� Clothas dryer <br />i Rangehood <br />� Exhauslfan <br />— Hoat pump <br />Unit hoalor <br />Boiler <br />— Relrigeration <br />Woodstove <br />— Olhor <br />CITY OF EVERETT LOCAL SALES TAI( CODE IS 7705 <br />I horoby cerilify Ihat I have read and examined Ihis application and know tha samo to bo Irue and correct. All provislons of laws and <br />ordinacos goveming lhis typo ol work will bo compliod wi�h wholher specifiod horoin or not. Tho granling of e permil does nol presume <br />to givo aulhorily lo violale or cancol tho provision of any other state or local law rAgulating conslruclion or the peAortnance ot <br />construction. Thal I am authorized by Iha owner of lhis property to perlorm Ihe work for which applicatlon is made and I compiy with tho <br />Stato Conlraclors Law 18.27 RCW and 2�36.200 WAC. <br />���✓ /� �EO.�i ���9L�% <br />