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SITE ADDRESS <br />-yo �.-v. <br />LEGAL LOT NO. <br />DESC. <br />OWNER . <br />v ����� �� <br />TENANTNAME <br />�1��" <br />CONTRACTOR `, /AS l%� <br />v <br />CONTR.UCENSE# � <br />�Uf)5 <br />USE OF BUILDING <br />PERMIT APRLICATION <br />CITY OF EVERETT PERMIT SERVIC�S <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettws.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />�f— ��z�3 �o�,�� �, <br />BLOCK TRACT <br />17J�� c� ,-� `j-1o�6 ��� ,,,� , <br />WORK DESCRIPTION <br />LL��«:�� <br />CONTACT FOR PERMIT <br />�U-- ' V�✓� <br />ADORESS Jj� J- <br />< <br />�� OD <br />PERMIT N <br />1-1 O U lyt %r! �`-�(l-% <br />C�TYTP PHONE �{ZS <br />- `L ���ti �6 zo� 5 �3 �'i,3 ; <br />PHONE <br />i�S� ���6-�S�S�' <br />HEAT SOURCE i1� <br />Electric _ Gas _ Olher <br />PHONE G� — <br />�O-/ c� U <br />/L7 , . / % s� J 7 0 :�/ <br />CONTRACT PRICE OF WORK <br />/,c/G> !li' <br />(Y / <br />�Ll.y- C \ ) �.�-�`-C.c;�� �L ��1.-�-� �� c�--%/� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposai <br />Dishwasher <br />Clothes.washer <br />Laundry tray <br />Sink (service/bar/mop/eta) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other -E-r �-"''� <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handlinq units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Ranga 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 ceritify that 1 have read and examined this application and know the same to be irue and correct. All provisions of laws and <br />ordinaces goveming this type of work will be complied vnth whether specified herein or not. The grantlng of a permit dces not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construdion or the performance of <br />wnstruclion. That I am authorized by ihe owner of this property to perfortn the Nn;� : k�r which application is made and I compiy with lhe <br />State Contractors Law 1827 RCW and 296200 WAC. <br />� G�.1! � ,l� ^ �i�.a��� �O-3'D�i' � <br />�---' -- --_.,..��..��,,..,.e.� e,.o.,� Date ^ <br />