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SITE ADDRESS <br />��),.�-., <br />/ �i(..� <br />LE�AL � LOTNO. <br />DESC. <br />OWNER <br />D� ��.D <br />TENANTNAME <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SER`✓ICES <br />3200 CEDP.R STREET, EVERETT, WA 98201 � <br />425-257-8810 - FAX 425-257-8857 - v�nvw.everettwa.org 5-� G- � <br />pPPLICATIONS ARE ACCEPl ED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />BLOCK I TRACT OR SUBDIVISION # <br />� <br />- -=� �� <br />CONTACTFOR <br />- ��^ ADDRESS � <br />CONTR. UCENSE # �L�� � G 2d�9 �� <br />USE OF BUILDING <br />��. <br />�I2;;)oR <br />HEATSOURCE <br />�� Elactric _ Gas _ Other <br />WORK DESCRIPTION %e Co�J-�T�J�=TIO� r%er J�/'�7g <br />n �% <br />� �,L/1_e. cxC�W1Cc�� <br />NO. I iYPE OF FIxTURE OR ITGh7 <br />�Toilel <br />13athtub <br />,"� Lavalory (w2sh basin) <br />Shower <br />� Kilchen sink 8 disposal <br />j_ Dishwe�her <br />Clothes washer <br />Waler healer <br />Sink (servicelbadmop/etc.) <br />f3ack0ow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease irap <br />Roof drains <br />Olher -- <br />LC-�L��-C(�I � <br />PERMIT # r II <br />%'� 5�7.� ��� I <br />PHONE <br />E•MAIL <br />��� PHON (^� <br />�/Dy �47�7��� <br />CONTRACT PRICE OF WORK <br />L• <br />_$ %G, � �. �%U <br />MtGt1ANIGHL <br />NO. I 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 ranye <br />Clothes dryer <br />Range hood <br />Exhaust (an <br />_ He2l pump <br />Unit heater <br />Boiler <br />Refri�eralion <br />Woodstove <br />Other <br />CITY Of EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriliFy lhat I have read and examined this application and know the same to be true and correcL All provisions ot laws and <br />ordinaces �overninp ihis type of work will be complied with whether specified herein or r,oL The granting of a oermit does not presume <br />to give aulhority to violate or cancel the provision of any olher state or local law regulating construction or Uie periormance of �, <br />construction. That I am au horized by �he owner o( this property to peAorm Uie work (or �vhich application is rt,ade and I comply with tne �� <br />Slale Conlractors Law 7�27 RCl7/and 296.200 WAC. �' <br />,�t <br />��' <br />