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SITE AD�i:2ESS <br />1� .,�5 <br />LEGAL LOT NO. <br />DESC. <br />TENANTNAME <br />,,,,,,,,,,,,,,,,,�o r5e �� <br />CONTR. LICENSE # <br />USE OF BUILDING <br />PCRMIT APPLICATIVN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - vnaw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4�M <br />PARCEL TAX I.D. # <br />BLOCK TRACT OR SUBDIVISION # <br />ADDRESS CITY/ZIP <br />�13�5 (�rancl �e k�v��l �if�� <br />I CONTACT FOR PERMIT PHONE <br />' 111�P �,(�fSU'1 E-MAIL <br />� noottess L`iT4Ttt�— <br />1a9o7 E, bibsen Rd ,Everet� qYaoy <br />HEATSOURCE <br />� Electric _ Gas _ Other <br />WORK DESCRIPTION +' r 1 ' �I 1 I <br />N1.W Iv�nG��I�D� � �lrTY� ftmUd�� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />BathWb <br />Lavalory (wash basin) <br />Shawer <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Waler healer <br />Sink (serviceNadmop/elc.) <br />Back(low prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease Irap <br />Roof drains <br />Other <br />PERMIT # <br />C ,' <br />PHONE <br />�3 339-09yG <br />Has- 3a�- �r3s <br />P 3a� as3s <br />CONTRACT PRICE OF WORK <br />� � soo. °° <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />Gas piping <br />W aler heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heal pump <br />Unit heater <br />Boiler <br />Reirigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify lhal I have read and examined Ihis application and know the saae lo be true and correcL All provisions of laws and <br />ordinaces governing lhis type of work will be complied with whelher specified herein or not. The granting of a permit does not presume <br />lo give authority to violate or cancel ihe provision o( any other state or local law regulating consWclion or the periormance of <br />construclion. That I am authorized by the owner of this property to periorm lhe work for which application is made and I comply wilh the <br />Stale Contraclors Law 18.27 RCW an�96.?,p0 WAC. <br />/�-U7 <br />'�i <br />