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SITE ADDRESS <br />L0T NO. <br />P�_RMIT APPLICAYII.N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STR[ET, EVERETT, WA 98201 <br />425-257-Ei810 - FAX 425-257-8857 - ww N.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />/ Gi9il/E ��jO.sl % � �� f 3/:50 <br />BLOCK � TRACT <br />5-�(�-O6 <br />PERMIT il <br />�y <br />OWNER ADDRESS CITY21P�u��3. �fNE <br />/� <br />ia � s�`, ,�irN�n. s cc. c �,21 �i �rccAG�G2. �,��20 3 <<.zs- 3 Ys o�d� <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />CONTRACTOR <br />�1.c�G/�� s%. <br />CONTR. LICENSE # <br />�VF_�/f$ a <br />USE OF BUILDING <br />ADDRESS CITYIZIP PHONE <br />f�T -�9/c �/,w PA�iFi� A�- G-v fzvi ,2��- 3/ry <br />,j �✓/�'L/%i%�Z <br />\NORK DESCRIPTION <br />Csq.S �'Gl/�/9� <br />{ Qu � <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />BathWb <br />Lavatory (wash basin) <br />Sho�ver <br />Kitchen sink 3 disposal <br />Dishwaslier <br />Clolhos �vasher <br />Laundry tray <br />Sink (servico/bar'mop/olc.) <br />Backflow p�ovenler <br />Urinal <br />Orinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other __ ___ _ <br />HEATSOURCE <br />_ Electric �Gas _ Othor <br />CONTRACT PRICE OF WORI( <br />'`��/ SY a <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handlinc� unils <br />T Forced air sysloms - <br />'� Gas piping - <br />Water heator <br />� Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Hoat pump <br />Unit healer <br />Boilar <br />Refrigeration <br />Woodstove <br />CIN OF EVERETT LOCAL SALES TFU( CODE IS 9105 <br />I hereby ceritify that I havo read and examined this application and know lhe same to be true and corre�'. All provisions of laws and <br />ordinaces governing lhis typo of work will bo complied with whether specified heroin or not. The c�rantinc� N a permil does not vresume <br />to �ivo authority tc violate or cancol the provision ot any o:her state or Iocai law regulating censlruction � the porformance of <br />construcjio That I am authorized by the owner of this property to perform the work fo� which appli�,uon is made and I comply �vith Ihe <br />Stato�G`ontr�tors Lav�18.27 RCW and 296.200 WAC. <br />