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SITE ADDRESS <br />_7 'D <br />LF.GA LOT � <br />DESC. <br />F� .;RMIT APPLICATI�,N <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 />APPIICATIONS ARE ACCEPTED FROM B AM TO 4 PM S—�/ /� <br />BLOCK <br />� G <br />PARCEL TAX I.D. N <br />TRACT OR SUBDIVISION R <br />JLl h 1'cfY�L �Y-o1' <br />TENANT NAME �� <br />� ( � � UN- Vi �/7� <br />�l/�-�?-< <? S,fi � � <br />CONTR. L�CENSE M �� � 7, Eu Z <br />`��6L <br />USE OF BUILDIRG <br />� <br />FOR PERMIT <br />PERMIT ll <br />S /oc� �o <br />CITYIZIP PHONE Z 6 <br />� � ���-�— _ 3 � _ c, <br />PHONE <br />f5 �.i � nur <br />c rc �� h� 4 p�,,� <br />HEATSOURCE <br />_ Eleclric _ Gas _ Other <br />WORK DESCRIPTION '`; s�/� /r G�� �h P/� S— <br />� � tC i� <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilet <br />Bath�ub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/barhnop/elc.) <br />Backflow prevenler <br />Urinai <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />rnvnc <br />�rryhH.�d 9�j <br />_{' o7G"� <br />CONTRACT PRICE OF WORK <br />�' � l'sb "' <br />NO. I TYPE OF FIXTURE OR ITEM <br />NC — air handling units <br />Forced air systems <br />Gas piping <br />Water heatei <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />I hereby cei tify Ihat I have read and examined this application and know the same to be true and correct. All provisions ot laws and <br />ordinances governing this type of work will be complied wilh whelher specified herein or not. The granting of a permil does not presume <br />lo give aulhority to violale or cancel the provision oi any other state or local law regulating construction or Ihe performance of <br />conslruction. That I am authorized by the owner of this property to perform lhe work forwhich application is made and I comply with lhe <br />Slate Coniractors Law 1827 RCW and 2�96�.20�0 /WAC. L/ <br />� �'�� G��vL. 5 / /I �! (7 <br />�/Z <br />� <br />