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SITE ADDRESS <br />LEGAI LO7N0. <br />DESC. <br />OWNER <br />TENANT NAME <br />PERMIT APPLICATlON <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 AGCEPTED FROM 8 AM TO 4 PM <br />II I PARCEL TAX I.D. # <br />BLOCK <br />,��c /-�S�uv� �3�1�'�� <br />�'�a� �- �=SrL <br />CONTR. LICENSE # <br />�✓b�, k <br />USE OF BUILDING <br />WORK DESCRIPTION <br />TRACT OR SUBUIVISION # <br />PERMIT # <br />�i <br />�� <br />CONTACT FO4 PERMIT PHONE 266' 22q�Y � <br />�"l^aV1� 50V rCSj E•MAIL <br />ADDRESS CITYIZIP PHONE <br />�`" I�`(�3S�3las� o�f2 <br />���,.��A 9a <br />HEAT SO�IRCE <br />Electric _ Gas _ Other <br />►wf,1 �ih� 1,L� 30� �r� Suj���rzsf't� �I��'' <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Dathlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clo�hes washer <br />Water heater <br />Sink (servicelbadmop/etc.) <br />Backtlow preventer <br />Urinal <br />Drinking Founfain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher�'�k6� <br />� <br />CONTRACT PRICE OF <br />1 6C�b' ot <br />/O Y�''JO V <br />MECHANICAL <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling uniis <br />Forced air systems ` <br />Gas piping ,, <br />Waler healer � v �,( �� <br />Gas fireplace C� t•/ � <br />�asrange <br />Clothes dryer ���G � <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit healer <br />Boiler <br />Retrigeralion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined this applica�ion and know the sume to be irue and correct. All provisions of !aws and <br />ordinances governing this lype of work wili be complied with whether speci(ed herein or not. The granting of a permit does not presume <br />to give authority to vioiate or cancel the provision of any other state or local law regulating construction or the performance of <br />construclion. That I am authori :d by the owner of �his property lo pertorm the work forwhich application is made and I comply with �he <br />Slate Contractors Law 18 RCW and 296.200 WAC. <br />�/., �� � J. IG <br />'�z <br />