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SITE ADDRESS <br />LOT ND. <br />WES-t�ON BU17" <br />sra�l su rr' <br />LICENSE N ,� _ <br />PERMIT APPLICATIOIV <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.evereriwa.org <br />APPLICATIONS ARE ACCEPTtD FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. • <br />BLOCK 7AACT OR SUBdVIS10N t <br />USE OF BUILDING <br />�Zi <br />FOH <br />�'l���n �cov�,J�l- <br />s�w�r�e � <br />HEAT SOURCE <br />Electric _ Gas _ Other <br />/-// D� <br />P RI+IR C <br />� 7r�-- oa <br />PHONE C�25\ <br />G�r'N � <br />9.3 �- �oIG <br />�ELH25 l - 3`+ � <br />NL L:�' 1 � � <br />,rp�, C2�) <br />�1 �_ 9� 6-17�1 <br />CONTRACT PRICE OF WORK <br />�o, Oo� <br />WORKDESCRIPTION (�jON'SrLUCTNRA'L�D� E%15T1�� ���'IL <br />�NP�PIT IMPf�OV�Y�t�(iC TM�nlr 20oM5� t-ob6Y� R*�a <br />S?AGE TD IP(CLUD.� Ts�NN�rJ�r '�'�' ^i1 .�T-c <br />z�-R � <br />NO. <br />0 <br />TYPE OF FlXTUHE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink S disposal <br />Dishwasher <br />Cloihes washer <br />Water heater <br />Sink (service/bar/mop/elc.) <br />8ackflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Rool drains <br />i Olher <br />NO. I TYPE OF FlXTURE OR REY <br />A/C — air handling units <br />Forced air systems <br />Gas pfping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustlan <br />Heatpump <br />Unit heater <br />6oiler <br />Re!rigeratlon <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TA7( CODE IS 3105 <br />I hereby ceritify lhat I have read and examined this application and know �he same to be lrue and correct. All provisions ol laws and <br />ordinaces goveming this rype of work will be compiied with whethar specified harein or not. The granting ot a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law reguiating constructlon or the performance ol <br />consiruclion. That I am aulhorized y�the owner of this property to pertorm Ihe work for which app�ica6on is made and I comply with the <br />State oniractors Law and�Y96.200 W AC. <br />/ <br />�. �.o� l <br />c�� an�rw nf Owner itractodA onzed Agent Date L <br />