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S ITE ADD RE � , <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />•11�-T% /'�0 � <br />TENANTNANE <br />PEkMIT AP�LICATION <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 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />� <br />� �, � - �v/�aoo -� y <br />BLOCK TRACT <br />ADDRESS CIN/ZIP <br />i�.o �'� �. �� �� � c-ol,P�s v�U � 9��-o I <br />� CONTACT FOR P RMIT <br />/ z -i 5-D(a <br />PERMIT # <br />no���a �03� <br />PHONE <br />S�1-t' � Sf�� e f� 2 e F� �J�a -Sa3'-L-r/7 <br />CONTRACTOR � AbDR[SS CITYlZIP PHONE <br />�uE�'�rrl�i�s,:�r ffu�l�/', f� 310,� �1��- �-�� 9��� �id-S=�B�65 /7 <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEATSOURCE <br />Electric �as <br />Other <br />WORKDESCRIPTION fJ�^i`j�''/(��,�y�c'�LI y��t/,L�T "�S��tr�C�- <br />�1 ! <br />NO. <br />G <br />TYPE OF FIX'i URE OR ITEM <br />Toilel <br />8athlub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water healer <br />Sink (service/badmop/elc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />CONTRACT PRICE OF WORK <br />NO. I NPE OF FIxTURE OR ITEM <br />A/C — air handlinq unils <br />Forced air systems <br />_(_ Gas piping <br />J_ water heater <br />Gas fireplace <br />Gas range <br />� Clothes dryer <br />_L Range hood <br />3 Gxhaustfan <br />Heat pump <br />Unil heater <br />Boiler <br />Refric�eration <br />Woodstove <br />_j Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritity lhat I have read and examined this applicalion and know the same lo be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with wiiether specified herein or noL The granling o( a permit does not presume <br />to give aulhority to violate or cancel lhe provision of any other slale or local lavr regulaling construction or lhe performance of <br />conslruction. That I am authorized by lhe oamer o` this property to perform the work for which application is made and I wmply with the <br />S�afe..Gonlraclors Law 18.27 RCW and 296.200 N'AC. <br />