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SITE ADDRESS <br />�� �, r N E;��-� <br />LEGA LOiNO. <br />DESG ia7�RC�f6� <br />Ih�i�r.� l-�ic<-„':�_S�C�C <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMI� SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 -- www.everetiwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />� v, iF A� <br />BLOCK <br />PARCEL TAX I.D. # <br />:>•�a s � �o o.; co �cc- <br />TRACT OR SUBDIVISION M <br />a��,.: i��-i'' i;vc- �� /K -,�'���.•� <br />� r�o ]-.�r <br />PERMIT # <br />�;,-�,�t �-v34= <br />.�,.>�7rc �15"71 <br />TENANTNAME I CONTACTFORPERMIT PHONE ��,Z(j� J,/�G�-✓ j.17 I <br />.i�'�,'i -%/�'� C'/�G'L�% Ci.'C�-C� E-MNL CI7�1(� -/'/�cTcc� e G•��:; . <br />.� al <br />!%�fifi[ TG"LN S-7Y7fJ21D�E'':�� T/dC �2 %�1✓' /�W�� %4� '�`7U i_ti�i'.s_-Y/ y16 3�9--�%C=i <br />CONTR. LICENSE N r'i?C 1 FTl�G' F l� jJ 3 ��'? `>h7d'% <br />USE OF BUILDING <br />HEATSOURCE <br />Eleclric � Gas � Olher <br />CONTRACT PRICE OF WORK <br />y./� � 2> <br />7ji )L4' � <br />WORK DESCRIPTION 1�L:77AC 7FJ1/,9sVT /MF'IOYE /'�IEN7 TL� c".; '/� � Ci :✓t u.�c A� <br />/�'- F:� c :/wri*r/T <br />N0. I TYPE OF Fl%TURE OR ITEM <br />Taifet <br />8athtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />�Water heater <br />preventer <br />Drinking F�I <br />Floor drain <br />Grease trap <br />Roof drains <br />Othcr <br />_ . , , ..—.. <br />NO. I TVPE OF FIICTUHE OR ITEM <br />NC - air handling unils <br />Forced air systems <br />Gas piping <br />Waten c�ater <br />Gas IireRlace <br />Gas range <br />Clothes drycr <br />Range hood <br />Exhausifan <br />Heat pump <br />Unit heater <br />Boiler <br />Fie�rigeralion <br />Woodstove <br />Olher <br />CITY OF EVEHET7 LOCAL SALES TAX CODE IS 3105 <br />I hereby cerili�,� that I have read and examined ihis application and know the same to be true and corred. All pmvicions of laws and <br />ordinaces goveming this tyGe ot work will be complied with whether specified herein or not The granting ot a permit does not presume <br />to give aulhoriry to violate or cancel the provision of any olher state or local law regulating constructi�n ar the peAormance of <br />construction. That I am authorized by the owner ol ihis pro�Ay to pedorm the work tor which application is made and I comp�y with the <br />State Contradors Law 7821 RCW and 2P6200 WAC. <br />'/� <br />