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SITE ADDRESS <br />� �s' a��:y� <br />LEGAL LOT NO. <br />P'tRNlIT APPLICATIV�V <br />CITY OF EVEi2ETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 4�5-257-8857 — www.everetlwa.org <br />APPUCATIONS ARE ACCEPTF.D FROM 8 AM TO 4 PWI <br />PARCEL TAX I.D. # <br />G�nSc�gG2'ja Z S�o� <br />6LOCK TRACT <br />L��fr ri Fi,.� E. ✓-%r��� s�s� <br />TEN�A)NT NAME <br />/"i4�=i"�l ��'7 � � ��r <br />CONiRACTOR <br />CONiR. I.ICENSE t! <br />USE OF BUILDING <br />WORK DESCRIPTION <br />(��JAot„nky , <br />CITY2IP PHONE <br />ir r <br />,�/�' Ov/ <br />gc�S 3r��rw,� r����fl ZU'v-3��-d';?�� <br />CONTACT�FOR PERMIT PNONE <br />(/(i.7ir'L ��it,�L `{2,� ZZ3 — a 5'( ( <br />ADDRESS CITY2IP PHONE <br />,gois (3� on�wn-� ErrY�N wn ti•gZ� j <br />HEATSOURCE <br />[leclric ✓Gas Olher <br />CONTRACT PRIGE OF WORK <br />n1o�� ��uri,� Sr�c,.� '� droi �S� ,� 9��5 <br />ajQDA�I�h� <br />NO. I TYPE OF FIXTURE OR ITEN <br />Toilet <br />Balhtub <br />Lavatory (wa�h basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Waler healer <br />Sink (service/badmop/elc.) <br />Backflow preventer <br />Urinal <br />Drinking Fouolain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Olher <br />AL <br />NO. I T1'PE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forcad air systems <br />Gas piping <br />Waler healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify that 1 have read and examinr.d this application and know the same to be true and correcl. All provisions of la�vs and <br />ordinaces governing lhis lype of �vork will be complied wilh whether speci(ied herein or noL The granting of a permil does not presume <br />lo give authorily to violate or cancel the provision of any other state or local law regulating consiruction or tho periormance of <br />construction. That 1 am authorized by the owner of this propeAy lo periorm Ihe work for which application is made and I comply with the <br />State Conlractor/s �aw 18.�2/7 RCW and 296.200 WAC. <br />//La� /�^-{.� � ///�3�b <br />I/ <br />Z <br />