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SI'fE ADDRESS <br />301� <br />LEGAI LOT N0. I <br />Df:SC. <br />OWNER �� <br />TENANT NAME <br />� ,cRMIT APPLICATI�'N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEbAR STREEf, EVERETT, WA 98201 <br />125-257-8810 — FAX 425-7.57-BB57 — www.everettwa.org <br />APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ( r C�'X.' ��(, %� � <br />I����� �,,,, a � PARCEL TAX I.D. A' PE(tM1T N <br />�a.�� � C �l, �I'�/`� <br />BLOCK � TRACT <br />CONTRACTOR L. /lm�� <br />d�P (� <br />CONTR. LICEN9E t _ . , <br />USE OF BUILDING <br />WORK D SCRIPTION <br />���'°� 203 <br />NO. I TYPE OF FU(TURE OR ITEM <br />� Toilet <br />Be�hlub <br />Lavatory (wash besin) <br />f Shower <br />_L Kitchen sink 8 disposel <br />�_ Dishwasher <br />� Clothes wasfier <br />__ Leundry trey <br />Sink (servicelbar/mopletc ) <br />� BeckOow preventer <br />~ llrinel <br />^ Dnnking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />�i(/E <br />CONTACT FOR PERMIT PHON[ <br />�l'�"�P1at l/�iheJ �ZS-75y - <br />pDORE35 v CITY2IP PHON <br />� !��' �� <br />9sis� S��.U�/oZ, ( ��'.�ii� <br />w� <br />HEAT SOURCE I CONTRACT PRICE OF WORK <br />Eledric ✓ Ges Olher <br />/�� � <br />W11, _ � <br />NO. I TYPE OF FIXTURE OR ITEM <br />NC — air handling unfls <br />Forced air systems <br />Gas piping <br />Water healer <br />1 Gae hreplece <br />L Ges rango <br />1 Clothes dryer <br />�_ Renge hood <br />Exheusllen <br />_ Heet pump <br />Unit heater <br />—` Bol�er <br />� ReMgeration <br />Woodstova <br />Other <br />CITY OF EVERETT LOCAL SALES TA7( CODE 19 7106 <br />I hereby ceritily thet I have read and exemined this applicalicn end know lhe aeme to be true end corted. All provislons ol lews and <br />ordinaces goveming ihis typa ol work vnll be comptied wilh whether apedfied herein or nol. 7he grenli�g ot e pt,rmlt does not presume <br />to give euthonty to violete ar cancel lho provision o1 eny other state or local law reguleting conatrudion or lhe performence of <br />constructioa That I em euthonzed by the owner of this property to perfortn lhe vrork for which epplication Is mede end I comply wilh the <br />State Contractors Law 18.27 RCW and 286.20G WAC. <br />Signature o wner/ onlractorl ul otlze Agent a e <br />