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SITE ADDRC-SS <br />�'/ L�G, <br />LGGAL LOT NO. <br />oesc. j <br />{ <br />P�RMIT APPLICATIC�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 4?_5-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />r���. <br />BLOCK <br />�PARCEL TAX I.D. # <br />�'i'o � i3i��o�3 <br />TRACT . <br />�2- s1-v'7 <br />� �!� •�� <br />� " _--_ <br />PERMIT # <br />�O%�� - U�� <br />F <br />� <br />Jo��.���,�s�,�= i•:'�'� m�oi C.-c�7,���frfh//s c.�r� �s<°Sz ��c-�9i-�a�s� <br />TENANT NAME � CONTACT FOR PERMIT PHONE <br />CONTRACTOR A�DRESS <br />,�/r/ft'i25�ti ��"'�i � 5 ��G /�J'���G'/ <br />CONTR. LICENSE p <br />USE UF 6UILOING <br />c��� <br />� / <br />WORK DESCRIPTION <br />! <br />NO. <br />� <br />��/�/fSGti' .5 �U� <br />CITYlZIP <br />G.��,�.;�%,��l=i�//s <br />�./�!1 9 � � $], <br />HEATSOURCE <br />_ Electric _ Gas _ Olher <br />�t%�.J �7�-"^"'S-�' � <br />TYPE OF FIXTUFE OR ITEM <br />Toilcl i 1 � <br />Dall.i�b � 1 <br />Lavalory (wash basin) � � �� <br />Shower 1 <br />Kitchen sink 8 disposal 1 <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (serviceNadmopletc.) <br />Back(low prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />� �� <br />,�0'�' C� `� <br />`�G'�- � �:5'/ <br />PHONE <br />3 �G -� i/-7 <br />CONTRACT PRICE OF WORK <br />�li`� I C 3 �� <br />IECHANICAL <br />ryp, I TYPE OF FIXTURE OR ITEM <br />A/C — air handliny units <br />�Forced air systems <br />Gas piping <br />L Water heater <br />/ Gasfroplace � <br />Gas range <br />i Clolhes dryer <br />i Rangehood <br />� Exhauslfan <br />Heal pump <br />Unit healer <br />Boiier <br />Refriger>lian <br />W oodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TA% CO�E IS 3705 <br />I hereby cerilify that I have read and examined lhis application and know the same to be true and correcL All provisions of laws and <br />ordinaces �overning lhis type of work will be complied wilh whrther specified herein or not. The granting ot a permil does not presume <br />to give authority to violale or cancel the provision of any oiher slate or local law rec�ulaling conslruction or tho periormance of <br />conslruction. Thal I am author�ed by 1he o�vner of this properly to periorm the work for which application is made and I comply with the <br />Slate ¢5ntractors Lav� 18.27 ��W�s1u�1 296.200 WAC. <br />,L/i/_ iG�: <br />