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SITE ADDRESS <br />iZ���/ 1�2�•.0 <br />LEGAL LOT N0. <br />DESC. <br />PcRMIT APPLICATI(�N <br />�ITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />��� <br />BLOCK TRACT <br />PARCEL TAX I.D. p <br />PERMIT # <br />CITY2IP F'r10NE <br />if�uL �t.�s,-,rV ;�,�v� 1'i2..n ('c Stz �t�ia2zt �'P2a� <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />r-t�aT C,c' `s�n�2Uvsti� � _co��,- <br />CONTRACTOR A�DRESS <br />�"j��F�C k'tYy�•,v�7 d <��. �;' �,L. � a (;c�•! ifn?% <br />CONTR. LICENSE N��_ � �� eTQ �y � �� '' <br />/ / � <br />USE OF BUILDING <br />'�^t •'r n`J.�-Ck <br />GivC��+c�.HiG/J <br />HEATSOURCE <br />_ Eloctric _ Gas _ Olhcr <br />PHONE � �� �l <br />`�2`j� 790 �f'27 <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION �L't n,o�� �.; ,� � 5;7,�g �C-L�= �, /^ s,�9r-L <br />/ <br />� G.,lq'-,-7.7�Y <'e+.-n/'rs� 77�-� /1� � LL `'� 7G• S's�u.� i M2T�ft- <br />NO. � TVPE OF FIXTUR[ OR ITEM <br />Tollet <br />Bathtub <br />Lavalory (wash basin) <br />Showor <br />Kitchon sink 8 disposal <br />Dishwasher <br />Cblha� •��ashm <br />Walor hoator <br />Sink (sorvicc/barlmoplolc.) <br />Backflow proven�or <br />Urinal <br />Drinking Founlaln <br />Floor draln <br />Groaso �rap <br />Roof dralns <br />Olhor _ <br />�� � O '3 )� �� <br />L/�,1�MA£'-iL TL � <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systams <br />Gas piping <br />W alor hoater <br />Gas firoplaco <br />Gas rango <br />Clolhos dryer <br />Rangohood <br />Er.hausl lan <br />Heat pump <br />Unil hoalor <br />Boiler <br />RelrigaraUon <br />Woodstovo <br />Other /'�' /�'a•< <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I horoby corilify that I havo read and examined Ihis application and know the sama to be true and corroct. All provislons ot laws and <br />ordinaces govorning lhis typo ol work will bo compliod with wholher specified heroin or not. Tho granling of a permil does not presumo <br />to givo auQiori lo violato or cancel tho provision of any olhor stale or local law rogulating consWclion or lho pedormanco ol <br />co str lion. at I am aulhorizAd by Uio ownor of Ihis property lo poAorm tho work tor which application is made and I comply with Iho <br />1�ie tr rs l.aw 18.27 RCW/ �and 29G.2001^lAC. <br />�� Ar�t. 1-�1 �_���'L K(lX7�y'� ��'�n.c,- rnC ���-�p�v7 <br />