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� SITE ADDRESS <br />LOT NO. <br />NAME <br />P�RMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETf, WA 98201 <br />425-257-8810 — FAX 425-[57-8857 — www.everettwa.org <br />ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK I TRACT <br />PARCEL TAX I.D. p <br />FOR <br />��. <br />.� ��,� <br />PFijMIT# /' <br />C� s �%'� - 30 <br />PHONE <br />.� J 3 V Lo (yGbs <br />CONTRACTO LC ADDRESS :.ITY21P PHONE <br />f-IiqH �1'oucr� /-1U:s1�5 �c � 9�aS 3S�{ AvG.��, �� y�2-3Y(.-G <br />CONTR. LICENSE # i ! . . . � . _ <br />USE OF BUILDING <br />WORK <br />3�JL�-17 <br />HEAT SOURCE <br />_ Electric � Gas _ Other <br />. � �Ic(,. <br />G' cJ sTon"l �`� WI �. ✓ �%� �. <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathlub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/elc.) <br />Backflow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Olher <br />CONTRACT PRICE OF WORK <br />NO. I 1YPE OF FIXTURE OR Il EM <br />A/C — 2ir handling unils <br />Porced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Reti igeration <br />Woo�islove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify thal I h2ve read and examined this applicalion and know the same lo be We and cortect. All provisions of laws and <br />oidinaces governing this type of work will be complied with whether specified herein or not. The granliny of a permit does not presume <br />to c�ive aulhoriry to violale or cancel lhe provision ot any other stato or local law rec�ulating consWction or the performance of <br />construction. That I am authorized by the owner of this propeAy to peAorm lhe work lor which application is made and I comply with the <br />Slale Conlractors Law,18.27, RCW and 296200 WAC. <br />� � <br />8-as-os <br />� �S'z 5 � <br />