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SITE ADDRESS <br />LEGAL LOT NO. <br />DESC. 34 �. <br />P�r�MIT APPLICATIO'ti� <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 FROM 8 AM TO 4 PM <br />BLOCK I TRACT <br />43�58290 34� ��/�'Zf <br />Nn� �- /�r�aeczs'E.,� �l I � 4a-r`' ?�. �.✓��� 4� -23 ► 9�i` <br />TENANTNAME I CONTACTFORPERMIT PHONE <br />O\�/�lw2 5,�-►�►�� <br />CONTRACTOR ADDRESS CITY2IP PHONE <br />CONTR.UCENSE# <br />USE OF BUILDING <br />Q, �ra�C1 � <br />CONTRACT PRICE OF WORK <br />2� po0 <br />WORK DESCRIPTION <br />A1�0 f�-rtAc.+-E � O "Z- c1}� C-�-�nt-C�.� -� �.�� S � � D, Pen"L �T' <br />�* cO�o9-o43 2�'-o��X z8'-o„ <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water healer <br />Sink (service/bar/mopletc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. I TYPE OF FU(TURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />N'ater heater <br />Gas Tireplace <br />Gas range ) <br />Clothes dryer A / � <br />Range hood / � <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify lhat I have read and examined this application and know the same to be true and corract. All provisions of laws and <br />ordinaces governing this type of work will be complied wilh whelher specified herein or not. The granting of a permit does not presume <br />to give aulhorily lo violate or cancel lhe provision of any other stale or local law regulating construction or the performance of <br />construction. That I am authorized by the owner of ihis property to periorm lhe work tor which application is made and I comply with the <br />State Conlraclors Law 1827 RCW and 296.200 WAC. <br />SignaWre of OwnedContractorlAuthorized Agenl Date <br />