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t <br />I <br />SITE ADORESS <br />C C/Gi <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />TENI1NTi Iy NAME <br />CONTRACTOR <br />CONTR. LICENSE it <br />USE OF BUILDING <br />PcRMIT APPLICATIvN <br />CITY OF EVERETT PERMlT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIO��S ARE ACCEPTED FROM S AM TO 4 PM <br />BLOCK <br />PARCEL TA.t I.D. # <br />TRACT <br />ICONTACTFOR <br />ADDR�SS <br />HEATSOURCE <br />%� Elecfric Gas Other <br />PERMIT # <br />l. C l'r �,-� - ���. �J <br />CITYIZIP PHONE <br />� �r��� �IdZ��/ `l'�52�iv-�9s1 <br />PHONE <br />CITY2IP PHONE <br />I CONTRACT PRICE OF WORK <br />WORK 7ESCRIPTION 1 y <br />J".^�C�C-iNC� dJ�/(Ji�.\1� ,�j�c`niN�i-Y�l�nc�.....� il'�«1-,..ul<��, il���{Urt���✓r+.61��, <br />F- � � <br />1Jp, I TYPE OF FIXTURE OR ITEM <br />x ron�i <br />Balhlub <br />A Lava!ory (wash basin) <br />� Shower <br />Kilchen sink & disposal <br />Dishwasher <br />�_ Clolhes washer <br />�- Waler hoater <br />� Sink (servicelbar/mop/etc.) <br />Back(low prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />1 Olher �e o�t��. '�'Q'� <br />— —r-- <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C – air handlinc� unils <br />Forced air systems <br />Gas pipin� <br />Water healer <br />Gas tireplace <br />Gas range <br />Clothes dryer <br />Ranye hood <br />Exhaustfan <br />Heal pump <br />Unit heater <br />Boiler <br />Re(rigeration <br />Woodstave <br />Other <br />CITY OF EVERETT LOCAI SALES TAX CODE IS 3105 <br />I hereby ceritify thal I have read and examined lhis applic2tion and know the same lo be We and correct. All provisions of laws and <br />ordinaces goveming Ihis rype of work will be complied with whelher speci(ied herein or noL The granling of a permil does nol presume <br />lo give authority to violate or cance! the provision of any other slale or local law regulaling conslruclion or the pedormance ol <br />consiruclion. Thal I M aulhorized by lhe owner of lhis properly to perform lhe work for which applicalion is made and I comply wilh ihe <br />SC3� .on ra 8.27 CW and 296.200 WAC. <br />. OLI/1�9C[Y 2Cb (c <br />