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SITE ADDRESS <br />� � y� <br />LEGAL LOT NO <br />P�RMIT APPLICATI� <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 />� �/ .s .— .s� F. <br />BLOCK <br />DESC. ( <br />� <br />OWNER <br />_� � f% <br />� v rYl <'. / `t '� ': <br />TENANT NAME <br />CONTRACTOR � L�r,�� ,�^ <br />Sq��e <br />CONTR. LICENSE # <br />USE OF BUILDING <br />��,�i�,� <br />PARCEL TAX I.D. # P�RMIT #� �i <br />�2,�'�� .30 �-c;�-,�-eJ� � - �%c� �� �C'J ` � � <br />TRACT <br />ADDRESS <br />J? y � o �t,�f° S T Vl �. <br />CONTACT FOR PERMIT <br />� r� <br />ADDRESS <br />t�l s` ct .f..7�, ,, r .C� <br />WORK DESCRIPTION � h �•�, /�,�� <br />L`.�luV ��� I�,�IS�(I1�jC� <br />�= `� Iu,U �.-7 S I NC� t.� �<`1 <br />PLUMBING <br />TYPE OF FIXTURE OR ITEM <br />f,Lsa <br />CITY/ZIP PHONE if a.� <br />'3 3.�', -� :� S`t <br />:s;��i2t;,�-.�,s� l-�� >s�-�yc� <br />PHONE <br />.� C� `j' � � �� � � 7 :� <br />CITY/ZIP PHONE <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />� Electric X Gas _ Other � � <br />S�Li.>e�7�✓'��c,�r �d�� LU IH�ot� t� ��3/��c� C� <br />��-c�-,� G����� lN-r� ��w�Jc� s'P���. <br />hti � L�r 2c�s I��v� jt,�Z� 0�.`} 6't�: X <br />Toilet C�,�G/si"�►� <br />Bathtub +Z� � s '�" 4�.u� <br />Lavatory (wash basin) J,:��i5� � <br />Shower �� i 5-E � �..� � <br />Kitchen sink &.dis�s�el�• P � uw.b; �.•� �:��5+,'�� <br />Dishwasher <br />Clothes washer .k. �[ � s '�-. � <br />' Water heater <br />I Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floordrain .szX� 5��� <br />Grease trap <br />Roof drains <br />Other <br />MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />�� Forced air systems <br />�,�, Gas piping � �C"� S� J�-y <br />�_ Water heater </ <br />� Gas fireplace � )C/s � � w � <br />Gas range 5 ( ,9y.- �'' <br />� Clothes dryer � W <br />� Range hood `"�, � J � ��,,�.�� <br />�_ Exhaust fan / � <br />Heat pump , r, ! � <br />Unit heater j,�j � <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />of Owne <br />Hgent <br />1 3 c `� <br />��2 <br />