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SITE ADDRESS <br />/yo� <br />LEGAL LOT NO. <br />DESC. <br />PERMiT APPLI�ATION <br />CIl'Y 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 />BLOCK <br />S�i znor�sc- �vG�aErC� � C.� <br />TENANTNAME <br />PARCEL TAX I.D. # <br />��as/�aa y� <br />OR SUBDIVISION # <br />HUUKCJJ �� <br />�l 3`f 3 t/oM�p✓r�-�e�� -�3sa <br />w�oa,-� f i3 e � c_C` C1-1- 9Z � <br />I CONTACT FOR PERMIT <br />L.�r�y 2� <br />CONTRACTOR l I�C���/��G ^� % �R�G <br />�� � <br />CONTR. LICENSE # <br />��L�/vli�lC/ +x /7 C /� /i�✓ <br />USE OF BUILDING <br />GOl�lt"'e `�`('G / `.�-1i <br />WORK DESCRIPTION <br />N0. I TYPE OF FIXTURE OR ITEM <br />PERMIT # <br />�� 7n� <br />PHONE <br />z��� 3G�� s-��� <br />CITY2IP PHONE <br />Cc6��.,,115 w.v f b�� 2r�� 3G� Sv�a <br />HEAT SOU�2CE • <br />_ Eleclric _ Gas _ Olher <br />Toilet <br />Balhtub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink 8 dispusal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (service/badmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other 1n��Jt�E<Z' Y�y4•�y(%7aau S`.�l <br />J <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR iTEM <br />� <br />A/C — air handling units <br />Waler healer � <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaust fan �o <br />Heatpump � � Zpp — <br />Uni[ healer / <br />Boiler � <br />Re(rigeralion / <br />Waodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify ihat I have read and examined this applicalion and know the same lo be true and correcL All provisions o( laws and <br />ordinaces governing this type of work will be complied wilh whether specified herein or not. The granting of a permit does not presume <br />to give authonty to violate or cancel lhe provision of any other state or local law regulating construclion or the performance of <br />construction. That I am authorized by lhe owner of lhis propeAy to periorm the work for which application is made and I comply �vilh the <br />State Conlractors Law 18.27 RCW and 29fi.200 WAC. <br />