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SITE AD�R�55� <br />S� <br />LEGAL LOT N0. <br />DESC. <br />OWNER <br />e <br />% �/ f' <br />TENANTNAME <br />PtRMIT APPLICATION <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 />DG��S� <br />BLOCK TRACT OR SUBDIVISION fl <br />'SL� /5'f� <br />CONTACT FOR PERMIT <br />PHONE <br />� �a9 -.o <br />PERMIT # <br />U5- b�. <br />10NE <br />�A�-//Z/ <br />COG� �p�C'7 S��'(��✓ � ADDRE55 ��Xr65'� f1r����%� �r� z�� <br />�� �7 L n � <br />CONTR. LICENSE # L ���� >P���C � /J/� ���, �S '�j�� � ��S <br />USE OF BUILDING <br />WORK DESCRIPTION <br />� <br />� <br />HEATSOURCE <br />_ Electric _ Gas _ O�her <br />V G �f..�¢� d "`J �'J-'. <br />N0. � TYPE OF FIXTURE OR ITEM <br />Toilel <br />Balhlub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwo�her <br />Cblhes wasner <br />Water heater <br />Sink (service/bar/mop/elc.) <br />Back(low preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR IT�M <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas ranye <br />Clolhes dryer <br />Range hood <br />Exhausl(an <br />Heat pump <br />Unit heater <br />Boiler <br />Re(rigeralion <br />Woodstove <br />Other _ <br />CITY OF EVERETT LOCAL SAIES TAX CODE IS 3105 <br />I here6y ceritify thal I have read and examined this application and know the same to be lrue and correcl. All provisions o( laws and <br />ordinaces govemin9lhis type of work will be complied wilh whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision o( any other state or local law regulaling construction or the pedormance of <br />construction. Thal I am authorized by lhe owner of lhis property to peAorm the work tor which application is made and I comply with the <br />State Conlraclors Law 18.27 RCW and 296.200 WAC. I <br />, �/ <br />��i.. . . L'� /��litt/r � � %i�! — � � <br />