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SITE ADDRESS <br />( �E� �T <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />�� �;� Y�r2 <br />TENANTNAME <br />.10� <br />CONTR. LICENSE tl <br />USE OF BUILDING <br />�"Y1'r't�E' <br />PtRMIT APPLICATIUN <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 ACCEPTED FROM 8 AM TO 4 PM <br />�i'iG� <br />BLOCK <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION N <br />� c� 0 J� �%T � r� v� <br />CONTACT FOR PERMIT <br />PERMIT # <br />' �} - <br />fYIZIP PHONE <br />9�z�3 <br />PHONE <br />�' / lrl l T �� r_„ ! n�nt uV S[7i <br />T �- 5`/Z� /z . --�-+ �-/L�����" �+� - � <br />WORK DESCRIPTION <br />��� ���� GJ*�r'rr�c,— <br />U <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />-- �athlub <br />Lavalory (wash basin) <br />Shovrer <br />Kitchnn sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (servicelbadmop/elc.) <br />Backllo�v preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease irap <br />Roof drains <br />Other <br />HEATSOURCE <br />_ Eleclric _ Gas <br />CONTRACT PRICE OF WORK <br />o�h�� ��,� �.�a r� <br />MECHANICAL <br />NO. � TYPE OF FIXTURE OR ITEM <br />NG — alr handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhausl fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y ihat I have read and examined ihis applicalion and kno�+� the same to be true and correct. All provisions of laws and <br />ordinaces gnverning Ihis rype of work will be complied with whether specified he�ein or nol. The grantinp of a permil does not presume <br />to give aulhorily to violate or cancel the provision of any other state or local 12w regulating consWction or lhe pedormance of <br />consiruction. Thal I am aulhorized by lhe ownefof this property to pedorm the work for which applicalion is made and I compiy with the <br />Slale Conlractors Law 18.27 RCW and 296.200 WAC. � <br />� �� , ` ` c_a� t_l � � L 1 t L � C � C `7 !� , !� .----�'.:%/ � � <br />Signature o( OwnedContractor/Authorized Aaenl�. � �a� . <br />