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. <br />SITE <br />til ��� � <br />L LOT <br />,.Jir�--r^.v � <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSF N <br />USE OF BUILDING <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SCRVICES <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 />/'1���� <br />BLOCK <br />CC�D <br />l'� LG� S ('O/�t P /7'l�x <br />�7 �'i n q f /%i�Cc' i%i,yrr <br />J <br />i M�Us�' i� 9,r/ c f� <br />/���,���� f✓�:» � <br />PARCEL TAX I.D. # <br />OD'/�/flOG�OI " , <br />TRACT <br />7�-00 <br />s7G�'/,li�, �z-� <br />CONTACT OR PE MIT � <br />,� Sl� � �..,��,t'�v <br />ADDRESS �! - <br />�C7/�' .Sy %�Ac^G��' <br />G��r ��eVc'�lS � 9 S?.�� <br />HEATSOURCE <br />_ Eleclric �Y Gas � Other <br />'% � <br />/9Y,� <br />CITY2IP PHONE <br />�7 Sl= J�S' -/!'�f <br />!�/J" �1� �' �/�iJ� <br />WORK DESCRIPTION ,�/ r J <br />/�t�� ��Sf�v,B<•d.-r,rr�,, /iGSftY •�l%�l�/lx�l�/1G c�f�1 <br />CONTRACT PRICE OF WORK <br />'s�, y�L <br />/{l�,r' Ncc�, f y c' r� s i�ll y �H as��r ,�'«�r0�1^, �r/,'G�c�U1.9./�y•�'rrr-� <br />_` 7/ <br />NO. I TYPE OF FIXTURE OR �TEM <br />�- <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backllow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR REM <br />A/C — air handling unils <br />_j_ Forced air systems <br />Gas piping <br />Waler healer <br />Gas fireplace <br />Gasrange <br />Clolhes dryer <br />Rangehood <br />� Exhaustfan <br />Heat pump <br />Unit heater <br />Boiier <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby centify ihat I have read and examined this application and know the same lo be true and wnecL All provisons of laws and <br />ordinaces governing this rype of work �+nll be complied with whether specified herein or nol The granti�g of a permit does not presume <br />to give authodty to violate or cancel ihe provision of any other stale or local law regulating conslruclion or lhe performance of <br />construclion. That 1 am authorized by the owner of this property lo perform Ihe work for which applicalion is made and I comply with th� <br />Slate Contraclors Law�18.2� RCW and 296200 WAC. �� <br />l/Z <br />