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SITE ADDRESS <br />Z� �J <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />'s ��� <br />TENANT NAME <br />�--- <br />CONTRACTOR <br />�� � <br />CONTR. LICENSE # <br />PERMIT 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 />I PARCEL TAX I.D. # <br />BLOCK TRACT OR SUBDIVISION # <br />GL`z�-7 —GYJ I�L��Lv00� 1 `'' <br />ADDRESS <br />USE OF BUILDING <br />�VYI�� f`/�/�%� ��S <br />WORK DESCRIPTION <br />J % L. <br />. T� � l. % . <br />! <br />u�, ���f sT� _� <br />CONT T FOR PERMIT <br />��'L�� ���t/,� �,4�� <br />ADDRE S <br />HEATSOURCE <br />� Electric _ Gas _ Other <br />, ' � fr" , , __ ' _ , i-•. _ 'r� � �l ( � n '� _ <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />/ Toilet <br />Bathtub <br />� Lavatory (wash basin) <br />_L Shower <br />_� Kitchen sink & disposal <br />_L Dishwasher <br />/ Clothes washer <br />� Water heater <br />Sink (service/bar/mop/etc.) <br />� Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO <br />� <br />� <br />CITY/ZIP n ('���F <br />`� �S <br />PHONE <br />E-MAIL <br />PERMIT # <br />,%' /C j D - �/ <br />i/ <br />CONTRACT PRICE OF WORK <br />MECHANiCAL <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems � <br />Gas piping � p� <br />Water heater J��Gt"�- <br />Gas fireplace l� <br />Gas range � <br />Clothes dryer � � <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <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 i<now 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 ow r of this property to perform the work for which application is made and I comply with the <br />State Cont�actors Law 18.27 RCW and 296�0 �AC. <br />0 �2G��0 <br />� <br />