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SITE ADDRESS <br />�`�04- <br />LEGAL LOT NO. <br />oesc. 2z TN � <br />TENANTNAME �, <br />� <br />CONTRACTOR � <br />f <br />CONTR. LICENSE # <br />USE OF BUILDING <br />D�j <br />� <br />PE�2MIT 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 />1 �V� t � <br />BLOCK TRACT <br />D -c c <br />WORK DESCRIPTION <br />�i,: s� (,�� l t s <br />PARCEL TAX I.D. p <br />ZG� ��-�a Z2v� <br />� �r � 2Q-� <br />FOR PERMIT <br />HEATSOURCE <br />�, Electric � Gas _ Glhcr <br />PLUMBING <br />NO. I NPE OF FIXTURE OR ITEM <br />Tcilel <br />Balhtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />W aler healer <br />Sink (service/bar/mop/elc.) <br />Back(low preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />J <br />t- �aj-{ ��s`✓Gt � W Q <br />PHONE <br />92�'�4�i2 9� <br />CITY2IP PHONE <br />CONTRACT PRICE OF WORK <br />'� d-rr-D . �g <) <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstave <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />i hereby cerilify that I have read and examined this applicalion and know the same to be lrue and correcL All provisions ui laws and <br />ordinaces governing this type of work will be complied with whelher specified herein or not. The granting oi a pertnil does not presume <br />lo give aulhorily to violate or cancel lhe provision o( any other stale er local law regulating construction or the performance of <br />construction. T6at I am authorized by Ihe owner of this property to perform the work for which application is made and I comply wilh lhe <br />State Con ac�e rs� w 18�.27 RCW and 296.200 WAC. <br />�\ V1�11I � � � ��� 6 {� <br />� �Z <br />