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SITE ADDRESS <br />LOT N0. <br />P��,RMIT APPLICATII. �V <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8fi10 - FAX 425-257-8857 - www.everettwa.org <br />APPLICAT�ONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />� G�42E <br />BLOCK TRACT <br />PARCEL TAX I.D. # <br />�—/(� ��� <br />PERMIT # <br />rn a�� - o �3a <br />DESC. J I I <br />OW NER ADDRESS CITYRIPMu �C3HON E <br />/ E'D <br />/a � S7` ,/�•9�it/G71- S LC C/,2/ �i �/c��IG�G�. �,�e2o 3 �z.s- 3 Ys D4a) <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />CONTRACTOR <br />EL�G/'�t� 5 � � �/�T • fl /c <br />CONTR. LICENSE # <br />t�VE%i% � � .Za-O / <br />USE OF BUILDING <br />�i <br />ADDRESS CITYIZIP PHONE <br />�/,2o P.9c�.r� •�9c�- Cv. ,�g�o� ,2�� - 3/i � <br />WORK DESCRIPTION �1, <br />�rq.s �l�/9� � �/'� G� - <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavalory (wash basin) <br />Showcr <br />Kitchen sink 8 disposal <br />Uishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backtlow provanler <br />Urinal <br />Drinking Fountain <br />Fioor drain <br />Greaso trap <br />Roof drains <br />Other <br />HEATSOURCE <br />_ E�ectric �Gas _ Othor <br />CONTRACT PRICE OF WORK <br />'�'y S�v <br />/ <br />�'� �J <br />N0. I TYPE OF PIXTURE OR ITEM11 <br />A/C - air handling unils <br />%- Forced air syslems <br />'� Gas piping <br />Waler healer <br />Z Gas firoplace <br />Gas range <br />Cbthes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit hoaler <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7705 <br />I hereby ceritify that I have read and examinod this apptication and know the same lo be true and correct. All provisfons of laws and <br />ordinaces governinc� this typo of work will be complied wilh whelher specified heroin or noL Tho granling of a permit does not presume <br />to givo authority to violate or cancel the provision o( any olher stato or local Iaw regulaling consWction or lhe pe�formanco of <br />construc�That i am authorized by tho owner of lhis property to perform the work for which application is mado and I comply with the <br />�Stat �ontr tors La 18.27 RCW and 29Fi.200 WAC. <br />�r-v �5� �( S��-7 � �� - F% l <br />