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SITE ADD�iESS <br />430 5.� <br />LEGALL LOT NO. <br />DESC f <br />( <br />P�RMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDA.R STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - wnM,v.everettwa.org <br />APPLICATICINS ARE ACCEPTED FROM 8 AM TO 4 PM <br />F�ftiF11 r�� <br />BLOCK <br />PARCEL TAX I.D. # <br />051S2��C�v^S� 0 <br />TRACT OR SUBDIVISION p <br />S `�-�F - �a <br />PERM�T # <br />5-nt�cltu�►}—t,�I�U�d�D l-Dhf�q ►yl p o. ��X I oo'f �✓e�tE%� 4'E206 <br />TENANi NAME CONTACT FOR PERMIT PHONE 2�G ZSZ"D td p <br />/Vj01�IL � CIAt�F �XP(1��SS I SfE✓E �+8fnu� e-Ma� si'{vctc��9'/ia�i�si�ca/t <br />--......._._.. p.srlloN Sl�r con7�. ��-- — <br />�2SSG✓e1�r�11(�lr�•�✓' s�¢�1tE qsln9 �ta6)Za2-o7da <br />CO�ITR.LICENSE# NR�iosci�rr�3 <br />USE OF BUILDING <br />,j+linMaQllF I�EpM2 d- S�/��lti5 <br />HEATSOURCE <br />Eleclric Gas Other <br />WORK DESCRIPTION <br />l�Na�t� or�F �✓F►J /�iu^'�N��ED G✓17�t f��i✓ p�aPG9� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />BalhWb <br />Lava�ory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (service/6ar/mop/e�c.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />CONTRACT PRICE OF WORK <br />„�� y S.�o ° <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />Gas piping <br />Waler healer <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heatpump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodslove <br />Other___ _ <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br />I hereby certify that I have read and examined this application and know lhe same lo be tr�e and correct. All provisions of laws and <br />ordinances governing this rype of worh will be complied with whethe� specified herein or not. The granting of a permi! does not presume <br />to give authonry to violate or cancel the provision of any other stale or local law regulating construction or the pedormance of <br />construction. Tha I a authorized by the owner of this property to perform the work for which application is made and I cumply with the <br />Slale Contractor L i}8.27 RCW and 296.200 WAC. <br />% ; 3, 2y-I o <br />Signature of O ne ntractodAuthorized Agent Date I <br />�Z <br />