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SITE ADDRESS <br />LEGALI LOT NO. <br />DESC.� a,p.� <br />D�L <br />CONTRACTOR - <br />Br.rrY �1/ec�n s � � n <br />CONTR. LICENSE # <br />USE OF BUILDING <br />�d✓cA,f��o n. <br />PERMIT APPLICATION <br />C�I'TY OF EV�RE7"T PERMIT SERVICES <br />3200 CEDAR STREET. EVF.�RETT, WA 98201 <br />425-257-8810 — FAX 425-257-9857 — www.everettwa.org <br />/APPLICATIONS ARE ACCEPTED FROM 8 L.M TO 4 PM <br />f'ARCEL TAX I.D. # <br />.',.� <br />BLOCK TRACT <br />�s7(s ctnf�,ru P�r'k �� #��oo � <br />CONTACT FOR PERMIT <br />��r ���.,s <br />pDURESS <br />S ys1`��t.s 7`!0o y�udeson R,cl <br />•� <br />I HEATSOURCE <br />PERMIT # <br />�G7c <br />PHONE <br />CITY2IP PHONE y1,(y <br />Er�rti �t 4�zo3 77c - 8d 3s' <br />��!�Iectric r-S�Gas _ Other <br />CONTRACT PRICE OF WORK <br />s; 8C7'� <br />WORKDESCRIPTION R,��,OVG d�a �ry�on C.oGlege C.ArB�„G� Z►1Sf�j,(I <br />1JGW Ca6��G�- exa�� �rz� G,nd Gonsfl�uef�'onfOw� Evc�es�' Ga6lege, <br />NO. I 1 TYPE OF FIXTIIRE OR ITEM <br />Toilel <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink & disposai <br />Dishwasher <br />Clothes washar <br />Water heater <br />Sinl: (servicelbadmop/etcJ <br />Backflow preventer <br />Urinal <br />Drinkin� Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />AIC — air handling units <br />Forcad air systems <br />G�s piping <br />Waler heater <br />Gas fireplace <br />Gas range <br />Ciothes dryar <br />Range hood <br />Eshaust fan <br />Fieal pump <br />Unit heater <br />�oiler <br />Retrigeration <br />N'oodstove <br />CITY O� EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby ceritify lhal I have read and examined this application and know the same lo be lrue and correcl. All provlsions ot laws and <br />ordinaces governing this type of work will be complied with whelher specified herein or noL The granting of a permit does nol presume <br />to give aulhority to violate or cancel the provislon of any other state or local law regulating consWct(on or the performance of <br />construclion. That I am aulhorized by the owner of this property to perform the work for which appiicatlon is made and I compty wilh the <br />S�ate Conlractors Law 18.27 RCW and 296.200 WAC. <br />SignaWre c( Owner/ConlractodAuthorized Agent Date �1 <br />