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(; �� , <br />, <br />� �l i�- <br />, j— -_ � � `':'!: `� <br />�- <br />SITE ADDRESS <br />`o -5 �a� <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />,r � ,, l% . (i, _ o,c <br />� ws � i �"�"G�.h <br />CONTRACTOR <br />2C 5'�=t��- � <br />>> <br />CON7R. ICENSE # Q �i <br />�� i i <br />USE OF BUILDING <br />��RMIT APP�_IC�4TIl,N <br />CI�"�Y OF EVERETT PE.RtViIT SERVIGES <br />3200 CEDAR STREET, EVERE'f�f, WA 98201 <br />425-25T-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO d�'M <br />V. �.T ``Q.-� <br />S�c <br />PARCEL TAX I.D. # <br />TRACT <br />ADDRESS <br />��,,�� 3 �� l � �, <br />CONTACT FOR Pf�RMIT <br />PERMIT # <br />C c�S�r <br />PHONE �i�/2 S� <br />r <br />_��fly���� r5�_ <br />PHONE <br />'j- --Y( ��o <br />�(j rl (S ^ 2-lZ�l7' S�'U CIT'!Z`P�w vC PH02�_— .� �O._ <br />9�s�36 � � <br />� (� ,1'�� �?� �( `2� <br />, _ <br />HEATSOURCE <br />Eleclric _ Gas _ Other <br />WORK DESCRIPTION I . <br />�,,,-�.e! l � �-� K�-�`�"�. c.�� °�uz`�ee� <br />"'�.�-�iL`� � �j =���� . <br />PLUNi81NG <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />DathWb <br />LavaLiry (wash basin) <br />Showe� <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Laundry tray <br />Sink (service/badmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain � <br />Grease lrap <br />Roof drains <br />Other F �_� <br />.U7 <br />CONTRAC'' PRICE OF WORK <br />5, �o 0 <br />IGAL <br />TYPE 6F FI%TURE OR ITEM <br />A/C — air handlir g un�ts <br />ForceG air systems <br />Gas pipinc� <br />Wster heater <br />Gas fireplace <br />Ga:: rangE� <br />Clc thes drycr <br />ftai�c�e hocd <br />Exh,�ust fan <br />Heat pump <br />Unit healer <br />Boiler <br />Refrigeralion <br />Woodetove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerili(y that I have read and examined ihis application and know the same to be true and correcL All provisions of laws and <br />ordinaces governing this type of work will be complied with �n�hether specified herein or not. The granting of a permit does not presume <br />to give aulhority to violate or cance� the provision of any other state or local law regulating consiruction or lhe performance of <br />construction. Thal I am authorized by lhe owner of tliis properly lo perform he work for which applicalion is made and I comply with the <br />Stale Corkiectac�aw 18.27 RCW and 296.200 WAC. / <br />�� /,��a �'�� io.. z?/o5' � <br />Sign ua re of OwnedContractor/Authorize . Dale �/� <br />