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SITE ADDR� ;S <br />LEGA LOT NO? � r <br />DESC. <br />OWNER <br />%(7✓� I/ lCa. <br />TENANTNAME <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8657 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />� c�%� a�so�-oho��� <br />BLOCK TRACT OR SUSDIVISION # <br />1� lUvn+ti -�S'Z�L <br />CONTR.LICENSEp li�, �,y� � <br />r� 5'S: <br />USE OF BUILDING <br />3l Cc,�.,i Ilc-� Lv�'t <br />CONTACT F R PF.RMIT <br />��Z� S�h�,,.,.k� <br />p <br />� �t�zo3 9�S-7sA- <br />PHONE 3G,� 73j-7y3yj <br />nuun�aa ••• <br />/�S'6 � GJ. 3� J=u�.G i�✓C�. �}.(�tma.r.� t+�rr <br />HEAT <br />_ Electric <br />WORN DESCRIPTION <br />t�vs�- G.�.,,. c, � � �J� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clo�hes washer <br />Water heater <br />Sink (service/badmop/etc.) <br />Dackflow prevenler <br />Urinal <br />Drinking Founlain <br />Flocr drain <br />Grease trap <br />Roof drains <br />Ofher <br />/�'/� <br />�OURCE CONTRACT PRICE OF WORK <br />Gas _ Other ���� � p � "— <br />/ �� <br />NO. I TYPE OF FIXTURE OR ITEM <br />A!C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Fxhaust fan <br />Heal pump <br />Unil heafe� <br />�oiler <br />Refrigeration <br />Waodstove <br />Other <br />CITY OF EVERETT LOCAI SALES TAX CODE IS 7105 <br />I hereby certity Ihal I have read and examined this application and know ihe same to be true and correct. All provisions ot laws and <br />ordinances governing Ihis type of work will be complied wilh whether specified herein or not. The granting of a pemiil Aoes not presume <br />to give authority to violale or cancel he provision of any other state or local law regulating construction or the performance of <br />conslruclion. That lem authori by the owner of ihis property to pedorm Ihe work for which application is made and I comply with the <br />State CoMraclors a 8.27 �'ifV and 296.200 WAC. <br />// �'��- �- z� -,� <br />,� <br />2 <br />