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SITE ADDRESS <br />LEGAL LO� <br />DESC. <br />OWNER <br />u F�'� L/ ff <br />TENANTNAME <br />I <br />PERIVIIT APPLICATION <br />CITY nF EVERETT PERMIT SERVICES <br />'�00 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. � <br />� `� - - 1?n � cx�o �/ <br />BLOCK TRACT <br />ADDRESS CITY2IP <br />�f�i�i�c'��- � 3/0� G � � � <br />� U I CONTACT FOR P� <br />CO TR �TOR l ADDRESS <br />t/ � il t%eU��h y/iUf�alQ��f y. .J %O j Lb��'� �tu � <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEATSOURCE <br />�/�6—O{ <br />PERMIT # <br />PHONE <br />_ �1�..���� - � S�� <br />CINIZIP PHON[ <br />9f1 �-o/ �/� S S8'6 .5—/T <br />_ Eleclric �Gas _ Other <br />CONTRACT PRICE OF WORK <br />��7.,�. __ <br />WORK DESCRIPTION �e �L����/�Gy�p�� �X t5f'I-�'tif ���C�jiQu-�c c <br />O <br />NO. I NPE OF FIXTURE OR ITEM <br />I TailCl <br />� Balhlub <br />Lavatory (wash basin) <br />Shower <br />Ki�clien sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Waler healer <br />Sink (service/badmop/elc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Flour drain <br />Grease trap <br />Roof drains <br />Olher <br />NO. � TYPE OF FIXTU1i: OR ITEM <br />A/C — air handling unils <br />Forced air syslems <br />�Gas piping <br />Wa�erheater <br />_ Gas fireplace <br />Gas range <br />�Clothes dryer <br />Ranc�e hood <br />Exhaustfan <br />Heat pump <br />Unit healer <br />Boiler <br />Refrigeration <br />Woodstove <br />CIT! OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritily thal I have read and examined this applicalion and know the same lo be true and comecL All provisions of laws and <br />ordinaces goveminc� this type of work will be complied �vilh whether specified hereir, or noL The granting of a permit does nol presume <br />to give aulhority to violale or cancel the provision of any other stale or local law regulating wnslruction or the per(ormance of <br />consfruction. Thal I am aulhorized by the otvner of lhis property lo perform lhe work for which applicalion is made and I comply wilh lhe <br />State �ontractors Law 18.27 RCW and 29G.200 WAC. <br />