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I <br />SITE AD�RESS <br />� � <br />LEGAL LOTNO. <br />DESC. <br />PFF�MIT �APPLICATION <br />�CITY 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 />� Z/ PARCEL TAX I.D. # <br />��..t GJa.r �3��07C�',: <br />BLO TRACT OR SUBDIVISION k <br />TENANT NAME / <br />� l�'vs �;�..a�c <br />(: <br />�'c�ry Nro�� sr��, <br />CONTR. LICENSE # <br />USE OF BUILDING <br />� <br />ICONTACT FOR PERMIT / <br />(� L� ��,SYoAI•t�,r r �uPJ iST <br />( <br />��� _�3�� - �i�� <br />PERMIT # , <br />1 ,1 ��� ��i�-- <br />L <br />PHONE�t���) 776-85'3� <br />.,�,�� w.�.�„y� N�, � 5., s <br />E-MAIL <br />Sy�{c�x�� 7�/CZ'� Mu��/r4�.i �v�si ��e're1t, iJs{ �'r�'�-D� <br />1 �5'hS) 776 - FS tf 3 e� <br />— HEAT SOURCE I CONTRACT PRICE OF WORK <br />EleGric _ Gas _ Other �� �5� a���� �� <br />WORK DESCRIPTION �' � � � .( � I � ,5 ,n -�cJ- � � <br />G J'i�Ct. G' � � •� � 4 <br />ji�.,i �tt��vi��..y �ll �G''� �� l�cc��- ����, ���c',.t �acE <br />�'1dd.t�Cc� on c.'.Xl`�r ip;- fa fc'�.✓c�y- _ <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Ba�hlub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />W ater heater <br />Sink (service/bar/mop/etc.) <br />Backflow preven(er <br />Urinal <br />Drinking Foun�ain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />4 I-4'y s f', �z� , , <br />cl,a.�.,�1 /���c�s <br />N0. I TYPE OF FIXTURE OR ITEM <br />NC — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas tireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unil heater <br />Boiler <br />Retrigeration <br />Woedstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />t hereby cerilify that I have read and examined this application and know Ihe same to be Irue and correct. All provisions of laws and <br />ordinaces governing ihis type ol work will be comp�ied with whether specilied herein or nol. The granting of a permit does not presume <br />lo give aulhority �o violale or cancel !he provision ol any other stale or local law regulating consUuclion or ihe performance oi <br />consiruction. Thal I am aulhorized by �he owner ot �his proper�y lo perform lhe work for which applica�ion is made and I comply wilh the <br />Stale CoMrac�ors Law 1827 RCVjI and 29/6200 WAC. <br />��cc�/i_,.� �Z2�( � ✓� r r' I.�JD�' <br />re ot UHtiCneonuac�orrr+uinunmu ryem � �a« <br />/Z <br />