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1r• <br />SITE <br />PE�MIi APPLlCA�ION <br />CITY OF EVERETT PERMIT SEPVICES �` 7_�6 <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 />LOT NO. I BLOCK <br />: . 'i'� i <br />/ PARCEL TAX I.D. # <br />2�51�3�e <br />TRACT <br />ADDRESS <br />���"✓°rt� .47 'N',�ki�' l�/�i <br />_� <br />TENANT NAME y'j�jQ�V �� CONTACT FOR PERMI' <br />riw/ ! <br />��� ��� <br />CONTRACTOR h�/]G�JNL� ���j���RESS <br />� Wan `�_��� <br />� <br />CONTR.LICENSE#�Q/jL�/A,AA/D2/� /�,'I/i b_ <br />/ �ni iy��•I �!� %U �l/ /r <br />USE OF BUILDING C� <br />/r��ii�(/ ��'� <br />HEATSOURCE <br />Electric � Gas _ Other <br />0#� ' �' <br />� PHONE <br />��f/ul3 <br />CITYIZIP PHONE <br />tu�� l�z�� ��3-� <br />WORK DESCRIPTION <br />G'��yhv��n �' �r ��i� �cii��f� �n��v��r:f <br />N0. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/badmopletc.) <br />BackFlow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />� <br />PRICE OF WORK <br />TYPE OF FIXTURE OR 17EM <br />A/C — air handling units <br />Force� air systems <br />Gas piping <br />Water heater <br />Gas f replace <br />Gas range <br />Clothes aryer <br />P.ange hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />I hereby cerilify that I have read and examined this application and know the �ame to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specifed herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />constryCU � Th�t I am authorized by lhe owner of this property lo perform the work tor which a�plication is made and I wmply with the <br />StatP/ ntract6fsYaw 182ZRCW and 296.200 WAC. <br />