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SITE ADO <br />ti''�/�f <br />DESC. <br />� f�sG� <br />LOT NO. � <br />CONTRACTOR <br />CONTR. LICENSE # <br />USE OF BUILDING <br />Fr�RMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — wuvw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TQ 4 PM <br />PARCEL TAX I.D. p PERMIT # <br />�/c�i a,G6a�5 - a/�- ��� Co7U S-U <br />BLOCK <br />,%. �' -n r� ���r w <br />s r-� <br />WORK DESCRIPTION <br />��i <br />'GL�ti,� (�. <br />1�,' c �- 1 �x f� <br />�aY�Jc'X �— .>�c � � �"; <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toile[ <br />BathWb <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Stnk (service/bar/mop/etc.) <br />Backilow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />TRACT �/ /OY�� fl �i G�47�S /7uC���iy�/ <br />U" <br />ADDRE55 CITY2IP PHONE <br />�G�v� H�✓l,,c.�lvi,�fL /1Ue%ll.� 5�a%�/,�1�. `�L <br />( CONTACTFORPERMIT <br />ADDRESS <br />HEATSOURCE <br />_ Electric �Gas _ Other <br />PHONE <br />CITY2IP PHONE <br />- `7't <br />�33 <br />CONTRACT PRICE OF WORK <br />I�' C � (o <br />!sxz� <br />� r� � �,ti ; ��o gv�r�,�,�,., �..�-.� �t-�%ti <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C — air handliog units <br />Forced air syslems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Cbthes dryer <br />Range hood <br />Exhaustfan <br />Heal pump <br />Unit heater <br />Boiler <br />Rofrigeration <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify that I have read and examined lhis application and know the same to be lrue and correct. All provislons of laws and <br />ordinaces yoverning lhis type o( work will be complied wilh whother specified herein or not. The granting of a pertnit does not presume <br />to give authorily to violate or cancel the provision of any other slate or local law regulating constructlon or the periormance of <br />construction. Thal l am authorized by lhe owner of this property to perform the work for which application is made and I compty with the <br />Stalp Qbnlracto[s Law 18.27 RCW and 296.200 WAC. <br />�—Z- <br />i <br />I�2 <br />