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SITE ADD ESS <br />_ J� G <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />��4✓E � ..�� <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE # <br />V�NS � <br />USE OF BUILDING <br />WORK <br />P�tRMIT APPLICATIO�V <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 />�� <br />BLOCK <br />L lrrc � <br />PARCEL TAX I.D. N <br />UD 3B�q�� <br />TRACT <br />CONTACT FOR PERMIT <br />7-9U� I/AN Sc <br />,��YC� /9iSiK. IAIC.ADDRES�O �'OX �30G�a <br />..i. D'L <br />HEATSOURCE <br />_ Electrir, � Gas _ Olher <br />n � <br />���'�GG�-. UG�c �i--�V^ � �Cno✓Ct}��pv. <br />NO, I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink F. dispcsal <br />Dish�vasher <br />Clolhes washer <br />W ater healer <br />Sink (service.badmop/elc.) <br />Backflow preventcr <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />z o0/OD <br />OD � <br />cmrzia <br />�, r �G�2 <br />� yz <br />C�I�T'Y�"2�IP�� <br />� v�Kyr <br />yeZo� <br />PERMIT N <br />C �5/ �-G�3 <br />PHONE <br />� Gi/� ��Zd <br />PHONE <br />� f��o �/`/i� <br />PHONE <br />�/z s B�o qyiy <br />CONTRACT PRICE OF WORK <br />30 <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />� Gas piping <br />Water healer <br />Gas f�replace <br />i Gas range <br />Cbthes drycr <br />�� Range hood <br />____�_ Exhaust fan <br />Heal {�ump <br />Unit healer <br />Boiler <br />Refrigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ccriti(y thal I have read and examined this application and know the same lo bo true and cortocL All provisions of laws and <br />ordinacos goveming Ihis lype of work will be complied wiUi whether specilied herein or noL The granting of a permit does not presume <br />to give authority to violate or cancel Ih rovision of any other state or local law rec�ulating construclion or the performance ot <br />conslruction. Thatyan� thorized b he owner of this propeAy lo perform the work br which application is made and I comply wilh the <br />Slate Contraeiors�Law t.27-RCW nd 296.200 WAC. <br />. ,-ii� / i '/ �?—/L�v� <br />