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SITE ADDRESS <br />(10 N�Y�_ <br />LEGAL LOT N0. <br />DESC. 3 ; �- 3 (� <br />1'�;Lirw � <br />TENANT NAfdE <br />%% � <br />CONTRACTOR <br />CONTR. LICENSE # <br />PERMIT APPLICATIOIV <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br />PARCEL TAX I.D. # <br />`-/S 66 �31�C js <br />BLOCK TRACT OR SUBOIVISION # <br />�r7 --ov Griqi.�,�vi�_w /-1 <br />��Gi.Q Cc��t_op 71� iaGYr AJ�� <br />C�w N ��/L <br />USE OF BUILDING <br />� I /J G( � ( -Q �4.t � L` <br />CONTACT FOR PERMIT <br />!�� I rN C,o �Lo <br />t7 A <br />4lJ�t1uN <br />HEATSOURCE <br />f � l Njl _ Eleclric ,�Gas _ Other <br />WORK DESCRIPTION <br />�.5� p��vTl�9 L �G'�QI Tlu•�J � <br />/�/ uS �n 4.i — ST.-CNO /N � C�l4(L�G L <br />N0. I TYPE OF FIXTURE OR ITEM <br />� Toilet <br />Bathlub <br />�.�.� Lavalory (wash basin) <br />_j_ Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Cblhes washer <br />Waler heater <br />Sink (service/bar/mop/e1cJ <br />Backflow prevenler <br />Urinal <br />Drinkin� Fountain <br />Floor drain <br />Grease trap <br />.�Roof drains <br />�' other I�d � �., (3 � ►3P� <br />�.� �2i.iT , WA `� <br />I �— I 3 <br />PHONE C'Z�--Z3 � ` [,� Q 6� <br />E-MAIL<<<'G�L�a�% t�COyLI <br />PHONE � � � <br />CONTRACT PRICE OF WORK <br />�L..�C � Srt 1 � �i �C�LJ,� �i <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air syslems <br />Gas piping <br />Waler healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit healer <br />Boiler <br />Re(rigeralion <br />Woodstove <br />Otheri XrTi.r✓D `Lk�Sj �Ny <br />CIN OF EVERETT LOCAL SALES TAX CODE IS 3'105 <br />I hereby ceriti(y that I have read and examined this applicalion and know lhe same to be true and correcl. All provisions o( laws and <br />ordinaces goveming this type of work will be complied wilh whether specified herein or not. The granting of a permit does not presume <br />to c�ive aulhority to violate or cancel ihe provision of any other slate or local law regulaling construction or the performance of <br />construction. That I am authorized by the owner of this properly lo periorm the �vork for which application is made and I comply with the <br />State Conlractors Law 18.27 RCV! and'296.200 WAC. <br />