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SITE ADDFESS <br />LEGAL LOT NO. <br />GESC /pZi <br />PERMIT APPLICATIGN <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 FP.OM 8 AM TO 4 PM <br />� (a�i <br />BLOCK TRACT <br />PARCEL TAX I.D. A <br />� <br />OWNER � ' .� y ! J�4DDRESj � ���r �/�Z IP PHONE � �.�yl� <br />iL.f,O � �Q.�2�1/P_/tf 9��� <br />TENANT NAI:E CONTACT FOR PERMIT PHONE <br />�/'�"�P1�c I/�heJ �F25 -75�{-lS�,'�' <br />CONTRACiOR <br />CONTR. LICENSE fl a/�,'O/������ <br />O� <br />USE OF BUILDING <br />WOZK DESC� <br />'� o� D � <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilel <br />�alhWb <br />Lava�ory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Oishwasher <br />Clo�hes wasfiei <br />Laundry iray <br />Sink (service/barlmop!elc � <br />�ackllow preventei <br />Urmal <br />Drinking Fountain <br />floor dram <br />Grease irap <br />Roof �rams <br />Other <br />pDDRESS � CITY121P '/ ,.,PHrONpE <br />� 7W �/� <br />9si5� 5<<e'f �t/�/oz, ��'�ti� <br />.4L /T <br />— HEAT SOURCE I CONTRACT PRICE OF WORK <br />Electric ✓ Gas Olher <br />��. <br />,,�- � <br />NO. I TYPE OF FIXTURE OR ITEM <br />NC - air handlmg units <br />%- Forced air systems <br />��_ Gas piping <br />• / � Water heater <br />/ Gas lueplace <br />_ � Gas range <br />_ i _ Clothes dryer <br />� Range hood <br />_�f_ Exhaustlan <br />Heat pump <br />UNt heater <br />Boiler <br />RefngeraUon <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />, I hereby cenhly that I have rr,ad and examined lhis apphcalion and know the same to be irue and correct. All provisions of laws and <br />Iordmaces goveming ihis type ol work will be complied with whether specified herem or not. The gran6ng ol a permit does not presume <br />to give authonty to vlolate or cancel �he provision of any other state or local law regula6ng consiruction or the peAormance of <br />� consiruction. That I am authorizetl by ihe owner of this preperty to pertorm �he work for which appGcation is made and I compty wilh the <br />State Contr lors Law 18 27 RCW and 296 200 WAC. <br />i ,.1. � '�: + � �� G�(o <br />Signa ure ot Ov�ne CoNractor/Aut�orized Agent ale �' <br />� <br />