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SITE AD�RESS <br />LEGAL � N0. <br />DESC. ��� r 1iJt" <br />RoSE FfOMes �Hc. �� �(� MIARiWG �Pi�f� ./1,IARYSVi//6� 9827/ �Le-(oSZ•75!/ <br />TENANTNAME � I CONTACTFORPERMI �— PHONE <br />_ ll�� �P�o�! A�o K.av .,S�rr� a�-�st- �sfi <br />ADDRESS CITYIZIP PHONE �e�(�Sj,�7S,°I <br />//7d6 /bJAR�'�u6 ,1iR� IViARf/s✓.%/� �/�L7/ <br />PERMIT APPLICATIVN <br />CITY OF EVERETT PERMIT SERViCES <br />3200 CEDAR STREET, EVERETT, WA 96201 �j � I G} �D� <br />425-257-8810 — FAX 425-257•8857 — www.everetlwa.org <br />APPLICATI�NS ARE ACCEPTED FROM 8 AM TO 4 PM <br />ALOCK I TRACT <br />PARCEL TN. .D. p <br />�.��� <br />G� !���- �_� <br />PERMIT M <br />,!ElD -,�3�0 <br />CONTRACTO,Rr <br />R0�3E f�roME.�� INc. <br />CONTR. LICENSE p <br />�jase N I y` 0�f2 vZ <br />USC OF BUILDING <br />�..�•r•n• <br />WORK UESCRIPTION <br />HEATSOURCE <br />[loclric ✓ Gas Other <br />CONTRACT PRICE OF WORK <br />[.oN.lTRuCTiON OF �Si N� I6 F�4+M17i Ly �L�jibENLL ! PL�iv a� 6A�� ��z/9 <br />NO. I T'PE OF FIXTURE OR ITEM <br />Toilot <br />�alhlub <br />Lavalory (wash 6asin) <br />Showar <br />Kitchen sink R disposal <br />Dishwasher <br />Clolhes washer <br />N/o er healor <br />Sinh (sorvicc�lbar/mop/cic.) <br />Backllow preveNer <br />Urinal <br />Drinkinc� Founlain <br />Fioor drain <br />Groase trap <br />Roof drains <br />Olher --- <br />N0. I TYPE OF FI%TURE OR ITEM <br />A/C - alr handling units <br />Forcod air systems <br />Gas piping <br />Wator hoator <br />Gas liroplaco <br />Gas rango <br />Clolhas dryer <br />Ran�s hood <br />Exhaust lan <br />Hcat pump <br />Unit healor <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />I hernby cerltify that I havo read and r.xaminod Ihis applicalion and know Iho same lo be Iruo and correcL All provisions of laws and <br />ordinaces c7ovemin� lhis lype ol work will bo compliod with whothm spociliod horoin or nol. The granling of a permil does not prosume <br />lo give authority lo violalo or cancel Oio provision of any othor statQ or local law regulaling construction or tho partormance oi <br />construr,tion. That I em authorizod by tho ownor ol this property to pnrtoim tho work for which application is made and I wmply wilh the <br />S�a�c Conlraclors Law 18.27 RCW and 296.200 WAC. <br />/o -i/. i 6 <br />