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SITE ADORESS <br />��_� <br />I LFGAL `LOTNO. <br />OESC <br />I OWNER <br />Ill�dN1K�0%l <br />', TENANTNAME <br />PERIV,IT APPLICATION <br />C{ fY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX �.D. N <br />�Ci '7 � � �'Li: v 7� <br />BLOCK TRACT <br />CONTACTFOR <br />PERMIT tl <br />�� h15-710� <br />PNONE <br />_ i�r4.� I�Ailc'�i�,=_ '�z5 7�s��/l�y' <br />I CONTRACTOR ADORESS CITY2IP PHONE � <br />� DAv o N� � E���,�n� �- H i � l�.G I�/ l3 �' A��. GG' L Ynl ti'�u��'� ti zs' 175 L• �I�c <br />, CONTR. LICEN9E � ��s� �j <br />_ �H ay �f['h1 � <br />'�� USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />_ Elednc �Gas _ O�her <br />WORK DESCRIPTION <br />�?E/'[qCE �Xl��rii�G- G-qS i�'C�i=n.ACE l,cl.'7N NLr'�tI <br />�Its FZt�nvR�'� • <br />NO. I TVPE OF FI%TURE OR ITEM <br />Todet <br />Bathlub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 uisDosal <br />Oishwasher <br />Clothes washer <br />Laundry iray <br />Sinh (sernce/badmop/etc � <br />BackOow preventer <br />Unnal <br />D�mkmg Fountain <br />Floor diam <br />Grease Irap <br />Roof drains <br />Other _ <br />NO. <br />MtGHANIGAL <br />TYPE OF FI11 fURE OR ITEM <br />A/C - av handling units <br />Forced av systems <br />Gas pipmg <br />Wate� heater <br />Gas fveplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Ezhaust lan <br />Heatpump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />Other <br />CITY OF EVERETT IOCAL SALES TAX CODE IS J106 <br />I herehy centify Ihat I have read end examineA Ihis apphcalion ad know Ihe same to be Imz and corted All proviswns olAws and <br />erdmaces goveming this type ol work will be complied with wlether spzaf�ed herein or not The granhng ol a pemiit does notpresume <br />to grve authonty to wolate or cancel the provision of any ol�er slate or local law regulatng construction or ihe perfortnanceof <br />conslruction That I am authonzed by Ihe owner ol this propeh to perlorm the work for which apphwtion is made and I complywith the <br />State Contrectors Law 182��� 29�WAC //— ��� <br />i <br />,�nl�'� t <br />