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SITE ADDRESS <br />LOT N0. <br />F'�.�RMIT APPLICATI�.N <br />CITY OF EVERETT PERMIT SERVIC�S <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 />PARCEL TAX I.D. # <br />s-16-o 6 <br />PERMIT# <br />11��i�US —� �i � <br />OWNER AUurtwa �.�� ��air�u lJ��__�a <br />7�/ /C'1/ <br />/oZ � Sf� ��12i �/G71. s CC. C/�l �i d/ccqC�GR. �,�'o?0 3 �l.z�- 3 YS O`da) <br />TENANTNAME � I CONTACiFORPERMIT PHONE <br />CONTRACTOR <br />ELe.�G/�t� S � • /�7YT ' fl /c <br />CONTR. LICENSE # <br />�v�-r�� s�s � za-o i <br />USE OF BUILDING <br />%/IEhi��2 <br />ADDRESS t'•ITY/ZIP PHONE <br />�/,�U PA�iF� �9� G-v �S�i .2�s� - 3/i l <br />WORK DESCRIPTION <br />Gq5 �r,o.,�.9� t Du �- <br />N0. <br />PLU <br />TYpE OF FIXTURE OR ITEM <br />Toilet <br />Bathlub <br />Lavatory (wash basin) <br />Showor <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (servicc/badmopletc.) <br />Backflow preventer <br />Urinai <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />HEAT SOURCE <br />_ Electric �Gas _ Othor <br />CONTRACT PRICE OF WORK <br />�'y,s'�D <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />%— Forced air syslems <br />'� Gas piping <br />Water heator <br />Z Gas fireplaco <br />Gas range <br />Cbthes dryer <br />Rango hood <br />Exhaustfa� <br />Neat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />I hereby cerilify thal I havo read and examined this application and know the same to be true and wrrecL All provisions of laws and <br />ordinaces governinc� this type of work will ba complied with whother specified herein or noL The grenting ot a permit does not presumo <br />to givo authorily lo violate or cancel the provision o( any olher stato or local law rec�ulating construction or ;he peAormance of <br />construcyo� That I am authonz�d by the owner of this property to porform the work for which application is made and I comply wilh tho <br />Stal9�ontr��tors La 18.27 RCW and 296.200 WAC. <br />�� i�� ,S //- .�/ <br />