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SITE ADDR?SS <br />9%�3 t:Ut'k <br />LEGAL LUTt10. <br />OESC. <br />/II�I�'Goo �'��iy <br />TENANTNAME <br />tiAv,� �a���n <br />P'�RMIT APPLICATIOI� <br />CITY OF EVERETT PERMIT SERVICES g_ 3�—f��j' <br />3200 CEDAR STREET, EVERETT, WA 98201 � <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org '1 � <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �O / v� <br />PARCEL TAX I.D. # P MIT # / <br />,cl lc/� Oo 4�o�oo``�007� n �� c q �� �}- <br />BLOCK TRACT UR SUBUIVISION N <br />�4��OX %�9 <br />CONTACT FOR PERMIT <br />���" `.�iri t 0 %.,O,C1 ���1lC�i�O.(J� <br />CONTR. LICENSE p <br />USE OF BUILDING <br />_;L'c't� ;1 /l , <br />WORK DESCRIPTION <br />�d oi��� <br />ADDRES <br />//d� - T,'Q, a't' . !3 , <br />HEATSOURCE <br />_ Electric _ Gas _ Other <br />, -��C ca� y' �'�-� �. <br />j i <br />NO. � TYPE OF FlXTURE OR ITEM <br />Toilet <br />Ba�htub <br />Lavarory (wash basin) <br />Shower <br />Kitchen sink 8 disposai --I� 0� ��, ad � <br />Dishwasher <br />Clothes washer <br />Water heater <br />S�nk (service/bar/mop/etc.)� � w I� I /, <br />Backllow preventer �'` <br />Urinal <br />Drinking FouMain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other _ <br />i�Uv%�� %6`��3 <br />PHONE 3�'O � 3 �' 33'�% <br />E-Ma� �1J1� � ,C'f'".�i�/o, <br />V���� PHONE O ��' : <br />.� 73 <br />CONTRACT PRICE OF YJORK <br />�'J 7 !i~%?� <br />� � ,���.s <br />N0. I TYPE OF FlXTUFE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />Gas pipinc� <br />Water heater <br />_ Gas (ireplace <br />_ Gas range <br />Clolhes dryer <br />_ Range hood <br />_ Exhaustfan <br />_ Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TA% COGE IS 3105 <br />I hereby ceritify that I have read and examined this applic�tion and know ihe same to be lrue and correct. All provisions of laws and <br />ordinaces-governing ihis type of work will be complied w�,n whether speci!ied herein or noL The graNing of a permit does no� presume <br />to give�authooty-to violate or cancel ihe provision of any other state or loral law regulatinp construction or the pedormance of <br />constr ct�. That I am autliorized by tlia owner of ihis property to peAorm the work for which application is made and I comply with tr,e <br />Slate ontractors Lap�18�7 RCW and 296.200 WAC. <br />C (� <br />� �� \ (L-�, � - G 1 f?� <br />