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�����U <br />C� <br />S�P � 6 t010 <br />�RLIC w�P�Ks <br />_.\L�\�'�\!� \����'\v�l� <br />PERNIIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />32C0 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - vnvw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />S% TE ADDRESS <br />e: �:23 ��U \t�'�-�7�'. ti�-�� Ll1 <br />LEGAL LOT NO. BLOCK <br />DESC. <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION # <br />PERMIT # <br />�1 UU�1 " �` <br />F.= I (� ( f—a L8� <br />VYII\CR ..- .... <br />�.an�o���r.nK L-I U� �.;'��:�OIZF��� ^� � S�n�. r=�.'��`�c;Sv� �C�� <br />TENANT NAME CONTACT FOR PERMIT {P�HONE� \ U �l 1 5 � <br />C�( f� F�-UC`?-� �� � �' <br />U���11� �,�'H\\� \� C\��.�\ � �VCa���\ E•MAIL��R-C�owt;4.-.ccr..CP�•ti.< <br />P O <br />P�ro::, S�c,n ���rnpuny <br />CONTR. LICENSE # <br />USE OF BUILUING <br />A�DR CIT l2 P <br />�osl��b�� l�ie CraKlanJ,CA�14bui S�os33��u`3 <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />Electric _ Gas _ Other I ��� ��'C� O� <br />'-1\�� � <br />WORF(DESCRIPTION ����O�C<<. � l��c.C�l�C�2_ W� l�aT�.�V`M�P�yQ 1 r l'� C�\�(-1�\�C���7� <br />S' ���`S'�/� ' � . s: o-ti� 3 P,��, �=,c <br />��-r_:� �t � S; U.�n �. ���.�C�z��; 2�i �=v iZ�"3 i S�a S�C�'t�\ C <br />��:.K,vuiz �' �2�c��t�cfc, S�Cr1->. L ��i��c�z�c 2i�i=v�'<3;Sla �r��`'�l <br />e...� .r1r..ilr��rv\ � <br />N0. I TYPE OF FIXTIIRE OR ITEM <br />Toilet <br />Balhtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />BackFlow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas freplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Healpump <br />Unit heater <br />Boiler <br />Refrigeration <br />Waodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certity that I have read and examined this application and know lhe same to be true and correct All provisions of laws and <br />ordinances governinq this type o( work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to ive-e Ihonry to iot te or cancel the provision of any other state or local law regulaling construction or lhe performance of <br />c nswcti That am uthorized by the ov+ner of this property to peAorm the work for which application is made and I comply wilh the <br />S�e Con actor Law 1 27 RCW and 296200 WAC. <br />� � J� �— \ � - \ l� <br />�lZ <br />