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SITE ADDRESS <br />_ /�-%�_"�',��( <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />�Sl�lay`-� �(�� w <br />TENANTNAME <br />CONTRAGTOR <br />CONTR. LICENSE # <br />USE OF BUILDING <br />WORK OESCRIPTION <br />�Cc-l�- � G ✓ <br />P�RM�T APPLICATIt�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAP. STREET, EVERETT, WA 96201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK <br />PARCEL TAX I.D. # <br />TRACT <br />I CONTACTFORPERMIT <br />I <br />�l S �{-1 i-�l <br />.J <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathlub <br />Lavalory (wash basin) <br />Shotver <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Waler heater <br />Sink (service/badmopletc.) <br />_ Backflow prevenler <br />Urinal <br />Drinkin� Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />AUDRESS <br />HEATSOURCE <br />Electric __ Gas _ Other <br />CIIYlZIP <br />�( -'a-�--U� <br />P MIT# <br />// ���� % <br />PHONCl�IZS) <br />l <br />757-9N�'4 <br />PHONE <br />PHONE <br />C:ONTRACT PRICE OF WORK <br />2 d., <br />� <br />EC <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplaco <br />Gas ran�e <br />Clolhes dryer <br />Range hood <br />Exhaust tan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES 1AX CODE IS 3105 <br />I hereby cerilify Ih2l I have read and examined this application and know the same lo be true and correcL All provisions of laws and <br />ordinaces goveming this type o( work will b� complied wilh v:helher speci(ied herein or noL The granling of a permil does not presume <br />to yive aulhority to violale or canr,el the pro��sion o( any oiher state or local law regulating construcliun or the perTormance ot <br />constr lion. atj� am a�ut�h-orized by !he owner of ihis preperty to perform the work for which applicalion is made and I comply with the <br />IStale ' nlra t rs �e�-:�LRCW 2nd 296.200 WAC. <br />Sig a <br />