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SITE ADDRESS <br />Gz� _SE <br />LEGA LOT NO. <br />�ESC. <br />OWNER � <br />C� � <br />�� ,t-�Gi �. � <br />TENANT AME <br />� <br />��-rlc� iit,- <br />CONTr�ACTOR <br />CONTR. LIC[NSE # <br />USE OF BUILD,ING. <br />P�RMiT APPI�ICATIOi.� <br />CiTY QF EVERETT PERMIT S�RVICES <br />3200 CEDAR STREET, EVEP.ETT, \NA 98201 <br />42a-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />. <br />- � ��J <br />BLOCK TRACT <br />ADDRE <br />,� <br />/�L <br />PARCEL TAX I.D. # <br />CONTACT FOR PERMIT <br />'P.y,Q.,�,�p <br />ADDRESS <br />HEATSOURCE <br />Electric Gas Other <br />WORK DESCRIPTION <br />) <br />�a �-�� ti� - � x � �',� <br />� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathfub <br />Lavatory (wash basin; <br />Sho��er <br />K�lcnen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Laundry lray <br />Sink (service(b2dmop/elc.) <br />DackOow prevanter <br />Urinal <br />Drinking Founlain <br />Flaor drain <br />Grease hap <br />Roof drains <br />Other <br />PERMI7 # <br />��S�U _ <br />CIN/ZIP PHONE <br />O�F'10E: Z$ PHONt <br />3.735�2Z11 <br />G�tt : Z�3 . � I . zQ'� <br />CiTYIZIP PHONE <br />CONTRACT PRICE OF WORK <br />NO. I TYPe OF FIXTURE OR IlEM <br />A�C — air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />f3oiler <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I her�oy ceritity lhat I have iead and examined this application and know lhe same to be true and correct. All provisions of laws and <br />ordinaces goveming this type of work will be cemplied wi�h whelher specified herein or not. ?he c�ranting of a permit does not presume <br />lo give authority to violate or cancel the provision of any other state or local �aw regulating construction or the performance of <br />consiruction. That I am authorized by the owner of this property lo perform the work for whicli applic;ation is made and I comply with lhe <br />3tale Cpntractors Law 18.27 R�1Nand?� 200 WAC. <br />/Y�.a�'. OJ <br />