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i <br />�i <br />� SITE A['ORESS <br />PERMlT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, V`J.4 98201 <br />425-257-8810 — FAX 425-257-8E57 — v�n•.n�r.evereth�da.org <br />APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM <br />I �'o,% LO C �'J % <br />� LEGA� LOT NO. BLOCK <br />DES�. <br />Ol4�NER <br />��"/,������f�ovJir.�E ���"/'a�'� <br />i TENANT NAME <br />j ��?���" <br />PARCEL TAX I.D. Y. <br />/�l-G�,'-t�vv-G��� <br />TRAcr oR sueoivisioN � <br />s/� 7 C� fG' f' F���E" <br />CONTACT FOR PERIlIT <br />�'n�✓ /✓C F�� <br />CONTRACTOR <br />�v�,��r ��=%���� a������y � �� <br />CONTR. LICENSE # <br />USE OF BUILDING <br />S`.� <br />Z��! <br />PERMIT # <br />Vl ( ZI I -0�2 <br />�� ��G.S. /�l I <br />PHONE _.� <br />�7.s� �—n�. 6 .: i b <br />HEAT S RCE coN7R/;c i r�tti�t ur wuntc <br />_ Electric _ Gas _ Other ���f L�� � <br />WORK DESCRIPTION <br />/����i/'��i�G�l �,�/ �iir�G .��"��pE-�c� <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEh1 <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water healer <br />Sink (service/bar/mop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof dra�ns <br />Other _ <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems- <br />Gas piping <br />Water heater <br />Gas f replace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaust fan <br />Heal pump <br />Unil heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other _ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />�' I hereby certify that I have read and examined this application and know lhe same lo be true and correct. All provisions of laws and <br />i ordinances goveming this type o( work will be complied with whether specif ed herein or not. The granting of a permit does not presume <br />�I to give authority to violate or cancel the provision of any other slate or local law regulating construction or the performance of <br />� construction. That I am authorized by Ihe owner of this property to perform ihe a�oB for which application is made and I comply with lhe <br />�Slate C ra ors Lavi �i327 RCW and 296.'00 WAC. <br />� 11�1���.0\�- <br />..,•m Wre ��ed��ontractor/Aulhonzed Agent Date <br />