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PL�ZIVIIT APPLICATI(��J <br />GITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERET7, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS 6Z O S� �f/�.�G � <br />��z��� r, w�-I 5'� <br />LEGAL LnTNO. BLOCK <br />DESC. i <br />S� V�V7H ,tiJ U& /'L �l ��l GL � <br />TAX I.D. # <br />"� zd'01/�oo?olf��oU <br />TRACT OR SUBDIVISIQN N <br />6za s'c �vc,.�� �v' wI� � wy , <br />�rfa„mit� �.✓,tl 9�'2 o�P <br />_ is -�c <br />.# <br />1/� --2d <br />TENANJ NAME �1 I CONTACT FOR PERMIT PHONE '�.0 �- cI'�%" �orP/ <br />��C'�LG'�1�G r�S�Qn /-��•�er�letr2 L�1C�.fQ` T� � t ( � <br />9 -�/t G L1�. E-MAIL CL�i��U�%�9�/C!'K/ <br />CONTRACTOR ADDR SS CITYIZIP PHO E 6 <br />� �. � <br />CONTR. L�CENSE # <br />USE O�F-BUILDING <br />/��E%SCrtt�r.✓cl /�'ct S I20 <br />HEATSOURCE <br />� Eleciric �Gas _ Olher <br />CONTRACT PRICE OF WORK <br />.� 3 � v, = <br />WORK DESCRIPTION �- <br />C'2ic>y4.e L'� "y-LS-T"� ��(�s Caccr<Nv7���'c�sii�o [:�,Z�. 2 �rc��2'�iC�El-[<u.c,^�vv`� <br />/i'O lL�i�J C�.YiC� �LC� '�L':�LE/'��07 �lirN'!� . <br />PLUMBING u1u�,.�,Z� <br />NO. I TYPE OF FIXTURE OR ITEM �Z�����C��T��, NO. <br />C <br />� <br />Toilet <br />BathWb <br />I_avatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Wa�er heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking FouNain <br />Floor drain <br />Grease irap <br />Roo( drains <br />Other <br />TYPE OF FIXTURE GR ITEM ��'✓L <br />A/C - air handling unils <br />Forced ar syslems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unil heater <br />Boiler <br />Refrigeration <br />Woodslove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerlify Ihat I have read and examined lhis application and know lhe same lo be irue and correct. All provisions of laws and <br />ordinances governing this rype of work will be complied wilh whether specified herein or no�. The granling o( a permil does not presume <br />to give authority lo violate or cancel the provision of any olher stale or local law regulaling construction or ihe performance of <br />cons�ruction. Thal 1 am aulhorized by the owner of lhis property to perform tfie work for which application is made and I comply with the <br />S�ate Conlraclors Law 18.27 RCW and 296.200 WAC. <br />�-- � �_��---.`'.� 7��� ��22/2�a%O <br />Signature o( Owner/Contraclor/Authorized Agenl Date �/Z <br />�r, <br />