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SITE ADDRE3S <br />LEGA� LOT NO. <br />DESC. •� i�� <br />P'CRMIT APPLICAI'IC�N <br />CITY OF EVERETT PERMIT �►ERVICES <br />3200 CEDAR STREET, E\�ERETi', WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS E\RE ACCEPTED FROM 8 AM TO 4 PM �� �a��05 <br />BLOCK � TRACT <br />PARCEL TAX I.D. # <br />2�1 OS 1'l 00 2l'31 O O <br />�.1►i.. �/iu�Ct� Mv\C.� �iLO WQ• ~• -• <br />12--. ST�lsl�:' �Pi2xN� �/ LLG [21q�] ��.a•pBp� <br />�_�.���.� P� � ���. �i�z,� <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />. � . . G�FF` ��AG�I�i"+ <�`4C�f��(J�'�./`_�+�+� <br />CONTRACTOR � r ^ ADDRESS CITYIZIP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING <br />�2� �� o�. �-� �..� �.F. <br />WORK DESCRIPTION <br />�"t��f�G�R..: T-Ic.�r-� � <br />i� F- 2-A CZ L�;. <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Dathlub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & o�sposal <br />Dishwasher <br />Ciolhes washer <br />Laundry Iray <br />Sink (servicelbar/mop/elc.) <br />�ack(low prevenlcr <br />Urinal <br />Drinkinc� Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />HEAT SOURCE <br />Electric _ Gas _ Other <br />CONTRACT PRICE OF WORK <br />2 � e�cx� <br />�_i. � TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas pipin� <br />Water healer <br />Gas fireplace <br />Gas ranc�e <br />Clothes dryer <br />Rangc hoad <br />Exhaustfan <br />Hea! pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby ceriti(y lhal 1 have read and examined this applicalion and know the same to be lrue and correct. All provisions o( lawa and <br />ordinaces goveminc� this type o( work will be complied with whelher specified herein or not. The grenting of a permit does not presume <br />to give authority lo violale or cancel the provision of any other state or local law regulaling construction or the pertormance of <br />construction. Th� a tfrorized the owner of this property lo pe�(orm tho �vo�k for which application is mado and I comply with the <br />S;ale Conlrac fs Law . RCW d 29G.200 WAC. <br />e 't `1 C� <br />SignaWro' fq OwnedCo tra rzedAge Date <br />� �(l. <br />