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SITE <br />PEkMIT APPLICATIC►Iv <br />CITY OF EVERETT PERMIT SER\/ICES <br />, �'- 3200 CEDAR STREET, EVERETT, WA 98:G01 <br />i' 425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />M�� APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />r <br />PARCEL TAX I.D. # <br />� � _ ; �_.r'�il <br />P�1o(� I�-C� <br />LEGAL LOTNO. BLOCK TRACT <br />DESC. <br />OWNER AD�RESS CITYIZIP PHONE <br />�!� f1Tflt�r�s��U n�u�-!w�'�'f-u. /o.7r'�,l��ave 9gaol y��-5=3o3—//zi <br />TENANT NAML'—�� C NTACT FOR PERMIT PHONE <br />�S(�h� � Sir��: e �ce � _ �'�5 =5U8 -bS�7 <br />Cv �Rp�7����v5' � ��k��'�L ADORESS CITYIZIP PHONE <br />E(�C�(i � �� 3�v7co;G'� ac�c, 98a-ol �l�-3v3-lr,�l <br />CONTR. LICI=NSE # <br />USE OF 3UILDING <br />W�C� CRIPTION R�rJ��� `^ <br />NO. <br />NPE OF FI%TURE OR ITEM <br />Toilet <br />Balhlub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Water healer <br />Sink (servicelbar/mop/elc.) <br />Oackflow prevenler <br />Urinal <br />Drinkin� Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Olher <br />HEAT SOUKi.. CON,TRACT PRICE OF WORK <br />./ N <br />_ Electric !/ Gas _ Other 9/%/7. G tJ <br />�Jy(U,�%�2-L �}G�lS'f"/�hG�. oC�C5��4�P�+GC <br />:a <br />IIYi <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas (ireplace <br />Gas range <br />Clothes dryer <br />Ranc�e hood <br />Exhaus! (an <br />Hcal pump <br />Unit heater <br />Doiler <br />Refrigeralion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify lhal I have read and examined this application and know the same lo be true and correcL All provisions of laws and <br />ordinaces governing lhis lype of work wiil be complied wilh whelher specified herein or noL The granting of a permil does not presume <br />tu give aulhority to violate or cancel the provision oi �ny olher slate or local law rec�ulating construclion or the peAormance of <br />construction. That I am authorized by Ihe owner of this property lo periorm the work for which applicalion is made and I comply with the <br />Slate,Conlractors Law 18.27 RCW and 296.200 WAC. <br />/) / �� . <br />