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SITE ADDRESS <br />�c,z �'� <br />LEGAL LOT NO. ('J <br />DESC Q <br />OWNER � <br />TENANTNAME <br />i <br />N�ERMIT APPLICATIUN <br />CI1�f C)F EVERETT PERMIT SERVICES <br />3200 CED,4R STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 —www.evarethnra.org <br />APPLICATIONS ARE ACCEPTED FkQM 8 AM TU 4 PM <br />�PARCEL TAX I.D. p <br />� <br />BLOCK I TRACT <br />�.� <br />� �-� �-� �vi< /���(/E 1/Oz � T�. �,,s . . ,... <br />�erie�r 9�-� <br />CONTACT FOR PERMIT PHONE <br />�I"P��LQ �/Q/,r�heJ �2S' -75�F. iS� <br />CONTRACTOR �,y�� <br />CONTR. LICENSE 0/, <br />L� <br />USE OF BUILDING <br />WORK D SC� RIPTION <br />LC.. _ . _ ''�'�cJ _5—' <br />uLL(,ULE.� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toile� <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink A disposal <br />Dishwasher <br />Clcthes wasfier <br />Lawidry iray <br />Smk (srrvicelbar/mop;etc ) <br />8ack0ow preventer <br />Urmal <br />Drmking Fountain <br />Floor drain <br />Grease trap <br />Rool drams <br />Othei <br />CIiY21P PHON <br />� '.�ZS-�S3 <br />9sis� 5��.t/�/oz, �r�'�iv�r,�' <br />� 5�70 <br />�� <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />Electnc �as Othar <br />/%:7��+ � <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />_ � . Forced air syslems <br />� - Gas pipmg <br />� Water heater <br />/ Gas 6replace <br />. / � Gas range <br />_ ( Clothes dryer <br />/ Range hood <br />-� Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refngeration <br />Woodstove <br />Other <br />CITV OF EVERETT LOCAL SALES TA%CODE IS J106 <br />I hereby cenlily that I havc read and ezamined lhis apphwtion and know ihe same to be irue end wrrect. All provisions ol laws and <br />ordmaces governing this type ot wurk will be complied with whether speafied herein or not. The gran6ng of a parmit does nol presume <br />to glve authority to violale or cancel the prowsion ol any other state or local law regulating conslruction or the peAormance of <br />constmchon That I am authorizetl by the owner ot Ihls property to perlorm the work lor which application is made end I wmply vnlh the <br />State Con acto La 18 27� and 296.200 WAC <br />_ ✓�c�e.- .�. /�o� l��>� <br />