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SITE ADDRESS <br />��LEGAL LOT NO. <br />ItNANINAMt <br />J 1 M v.�Z' l, <br />CONTRACTOR r�LSKG <br />CONTR. LICENSE # <br />USE OF BUILDING <br />t <br />P�RMIT APPLICATION <br />CITY OF EVERETT PERMlT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-E810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK <br />�' D�vd+�rE,2S <br />PARCEL TAX I.D. # <br />'L�3 5 ( dD0 <br />TRACT <br />CONTACT FOR PERMIT <br />5 <br />a v i ��ao� i- <br />PHONE <br />ADDRESS Z?iII S`J F�� (CO, CITY2IP PHONE <br />�vt.'J�tJ�kW/} <br />�=CLSK D(�� 6 � �,' <br />��-2��,2 S �y � <br />WORK DESCRIPTION <br />�l9� �(- LA� 5 <br />HEAT SOURCE <br />_ Electric _ Gas _ Otiier <br />CONTRACT PRICE OF WORK <br />% <br />C�1 � N-6 F w i�'i'Ft2 �1 �TL �2 T,� <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhlub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothas washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Rcof drains <br />Other__ <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />EAhaust(an <br />Heat pump <br />Unit heater <br />Boiler <br />Re(rigeration <br />Woodslove <br />CITY OF EVERETT LOCAL SALES TN: CODE IS 3705 <br />I hereby cerilify lhat I have read and examined lhis application and know lhe same lo be true and correct. AII provisions of laws and <br />ordinaces governing this lype o( work will be complied with whether specified herein or nol. The granting of a pertnit does not presume <br />to give aulhority lo viotate or cancel lhe provision of any other state or local law reguiating construction or the pedormance of <br />conslruction. That I am aulhorized by the owner of this property lo perform lhe work for which applicalion is made and I comply with lhe <br />State Contraclors Law 18.27 RCW and 296.200 WAC. <br />Signalure of OwnedContrectodAuthorized Agenl Dale <br />