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SITE ADDRESS <br />� 1'ly <br />LEGAL LOT NO. <br />DESC. a I. L . <br />NAIdE <br />PtRMIT APPLICATIUN <br />CITY OF EVERETT PERMIT S�RVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.ory <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />OL6CK <br />yRl <br />CONTRACTOR� � L <br />��i1�L�'A ���Y�gl <br />CONTR. LICENSE # <br />L <br />USE OF BUILDING <br />PARCEI TAX I.D. # P� IT # <br />00 �yfilD��Do /i/7Z%`���� <br />TRACT � �� � ..- — _-- <br />�l% l'n'i? G.� <br />PERMIT <br />ApDRESS <br />i�s�as N�' 1'.c. sr. <br />WORK DESCRIPTION <br />�{,FZk! �'rncti t <br />NO, I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Balhlub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry hay <br />Sink (service!badmop/elc.) <br />�ackilow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other _ <br />HEATSOURCE <br />CINIZIP <br />5�,�/um�sh yp�,�,� <br />4'i1. <br />Electric �jC Gas _ Other <br />��-t� ca�.�- <br />PHONE <br />,� �7--iJ.) <br />PHONE <br />�ia5-3d7- �J535 <br />CONTRACT PRICE OF WORK <br />4 �. 'l.�li OC� <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air syslems <br />Gas piping <br />Wator healer <br />Gas (ireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhauslfan <br />Heal pump <br />Unit healer <br />Boiler <br />Refric�eration <br />Woodstove <br />O�her <br />CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y that I have read and examined this applicalion and know the same to be Uue and correcL All provisions of laws and <br />ordinaces goveming lhis type of work will be complied with whelher specified herein or nol The grentin� of a permit does not presume <br />to give authority to violate or cancel ihe ; rovision oF any olher stale or local law regulating construclion or the peAormance of <br />construclion. That I am aulhorized by the owner of Ihis property lo peAorm tho work (or which application is made and I comply with Ihe <br />Slate Contractors Law 18.27 RCW and 29G. WAC. <br />` l GC:- �j '��'r'��5� <br />Signature of OwnedGor,tractor/Aut iorized Agent y Date <br />