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SITE ADDRESS � <br />L <br />LEGAL LOT N0. <br />DESC. <br />OWNER � <br />TENANT NAME <br />Picr�MlT APPLICATIOt <br />CITY OF EVERETT PERMIT SERVICE5 <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.f+veretlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM L���� ��-� � <br />12� �Irn�►+e <br />� BIOCK <br />CONTRACTOR L. /1m�Q <br />f,�Y{� <br />CONTR. LICEN�E R , . „ „ � <br />USE OF BUILDING <br />WORK D SC� RIPTI�N � <br />�[ l;b<JLei <br />TRACT <br />PARCEL TAX I.D. N <br />;�iUE �/02 <br />PF�iM1T � <br />�• i- / <br />ICONTACT FOR PERMIT PHONE <br />�I'P��.L�c �/Ql�iheJ �15-75 <br />pDDR[SS � CITY/ZIP PHONpE <br />�� ���/ � <br />9�5� �{-� iC/�/DZ� �Q+�° �o�f/!/Ld' <br />/i"70 <br />G'✓A- <br />- HEAT SOURCE I CONTRACT PRICE OF WORK <br />Electric ✓ Ges Other <br />Zb�l , , <br />j����/ <br />NO. � TYPE Of FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Levelory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwesher <br />Clolhes wasfier <br />Leundry trey <br />Sink (serv�:ePoadmopletc.) <br />Beckflow preventer <br />Urinel <br />Drinking Fountain <br />Floor drain <br />Grense irep <br />Roof drains <br />Olher <br />NO. � TYPE OF FI%TURE OR ITEM <br />AIC — air hendling units <br />�Forced eir eystems <br />Ges piping <br />Water heeter <br />1 Gas fireplece <br />� Ges range <br />�_ Clolhes dryer <br />_L.. Renge hood <br />Exheustlen <br />_ Heet pump <br />UNl heeter <br />� Bollar <br />� Refrigerelion <br />Woodstave <br />Other <br />CITY OF EVERETT LOCAL 8ALE8 TA% COUE 18 7706 <br />I hereby ceritiiy Ihet I havo read and exemined Ihfs epplicellon end know the same to be trun end cortect. All provlslona ollews end <br />ordinaces goveming lhis type ol work wi�l be complied wilh whether upedfied herein ot not. The grenting of a pertntt doea not presume <br />to give euthority to violala or cancel tha provision ol eny othor slete or local law reguletlng conslrudion or the perlortnance ol <br />construction. Thet I am euthorized by ihe owner ol lhis property to per(ortn Ihe work for whlch epplication Is mede end I comply with the <br />Stete Contractors Law 18.27 RCW end 298.200 WAC. <br />_ %�/r� <br />ignature o wned oNrnct• �IAut orize genl � 8 B <br />l ' <br />