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SITE ADDRESS <br />t2Zc� f� <br />LOT NO. <br />`� ! %, <br />P�RMIT APPLICATIC,�V <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 ACCE?TED FROM 8 AM TO 4 PM <br />BLO(.K � TRACT <br />PARCEL TAX I.D. # <br />�qoSl'1�021�100 <br />�1 C> S � 1 6�Jz.i z c�l) r <br />iz -s-o <br />I��t'=' `ST���. P�n.xN�.s �.Lc. �aiq� �i�u.�c�� N�vk.� ��o WQ• �' • <br />� � �.--r.,rt.� PL '� w�. ��P�2,� �y'8•�1 <br />TENANTNAME I CONTACTFORPERMIT PHONE <br />l � . ��r� � C` � <br />• .. ;-•z `si �R 4Z,.a�3`-FB-��� <br />: <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />CONTR. LICENSE #: � <br />USE OF BUILDING <br />12.�5\ O�:"� \"I A.L.. `�.F <br />WORK DESCRIPTION <br />�'"'C`_,��G��,.; ��I c9� � <br />����F��L � <br />Np. I TYPE OF FI%TURE OR ITEM <br />Toilcl <br />Balhlub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Cb�hes washer <br />Laundry tray <br />Sink (service/barhnop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />� . � ., . . <br />HEATSOURCE <br />_ Eleclric _ _ Gas _ Other <br />✓ <br />`'� <br />�• i• , <br />CONTRACT PRICE OF WORK <br />2 7 `�7!X� <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />Gas �iping <br />Waler heater <br />Gas fireplace <br />Gas range <br />Clolhes drycr <br />_ Ran�e hood <br />Exhaustfan <br />Heal pump <br />Unit heater <br />Boiler <br />Refric�eration <br />Woodslave <br />CITY OF EVEREIT LOCAL SALES TAX COOE IS 3105 <br />I hereby ceritify that t have read and examined this applicalion and know the same to be Irue and correct. All provisions of laws and <br />ordinaces c�ovemi this type of work will Le complied with whether specified herein or noL The granting of a permit does not presuma <br />lo give authority to iolate or cancel the provision of any olher stale or local law regulating construction or the performance of <br />construction: TI� l� �-aulhorized by lho owner of this pr�perty to periorm the work for which application is rr�ade and I comply with lhe <br />Stale Contr eCors L� 8.27 RCW nd 29�.200 WAC. <br />_c��-„� `� I i `t� ( �S <br />Signat o of Ownod onlr �u orized Ac� t Dale ��Z <br />