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S�TE AUDRESS <br />,��; 95 ry � <br />LEGAL YYi N0. <br />DES(:. (,/Ni! '� �� <br />OWNER <br />Kos � <br />TENANTNAME <br />CONiRACiOR l�a'S �`- <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.evereltwa.org <br />APPLICATIONS ARE ACCEPT FROM B AM TO 4 PM <br />t r •S� E <br />BLOCK <br />��. / i <br />4/ Lts <br />PARCEL TAJ( I.D. p <br />:�7p6' /,NOp 30 <br />TRACT <br />/1//ALi�tC JJ,[. <br />CO TACT OR PERMIT <br />�1V �o/�I /+ U <br />AODHESS s�qMf <br />� �- ���-�7� <br />PERMIT # <br />yao C 'I6'i ' �5�� <br />CITYIZIP 9�,17/ PHONE <br />(s ✓i'//C 3Fe -GSL-7SYi/ <br />PHONE <br />7 <br />G YTE..eL 3E+n -G4-L' 7S'�/ <br />CITY2IP PF10NE <br />CONTR. LICENSE N �� �'SZ 7�� <br />�ose= /,!•I �`� yz�z <br />USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br />S �. � I _ [loclric " Gas _ Othcr <br />WORK DESCRIPTION <br />nc..Js-/�aeLTi�ci✓ D/ �;'i•..��t' /�r�lM��� �I4N-JCEd�1�rNiE��iwSi��.2/fiJ <br />NO. � TYPE OF FIXTURE OR ITEM <br />.3 Toilot <br />�� Ba�hlu6 <br />� Lava�ory (wash basin) <br />� Shower <br />�Kitchr.n sink 8 disposal <br />Dishwasher <br />�_ Clolhes washor <br />Y` Watur healcr <br />— Sink (sarvir.e�barlmop/clr,.) <br />— Backllow provr.ntor <br />— Urin21 <br />— Drinkin{� Fountain <br />�-- floordrain <br />— Greaso tiap <br />� Rool drains <br />^`� Olher _ <br />NO. I TVPE OF FIXTUHE OR ITEM <br />_a <br />s <br />A/C - air handling unlls <br />Forcod eir systems <br />Gas piping <br />Watcr haator <br />G2s liraplaco <br />Gas ranc�o <br />Clolhes dryer <br />Rango hood <br />Exhaustfan <br />Heat pu:np <br />Unit heatar <br />Bollor <br />Relrigeralion <br />Woodslove <br />Olhor <br />CITY OF EVERETT LOCAL SALES TAX CODE IS �105 <br />I hereby ceri�ily Ihal I have read and examined Ihis application and know the same lo bo tmo and correct. All provlsions of laws and <br />ordinaces governing this lype ol work will bo complied wilh wholhor specificd horein or nol Tho granting ol a parmil does not presume <br />to c�ive aulhonly to violale or cancel tha provision ol any olher s:ale or local law regulaling construclion or Iha porlormance of <br />conslruction. That I am aulhorized by Iho ownor ol this properN to poAorm tho work lor which application Is mado and I comply wilh tho <br />S�ato Co�lractors Lawy� .27 RCW and 29620D WAC. <br />Y ., J,[%�1 �/��/�� <br />