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SITE ADDRESS <br />� r�r < <�.�e <br />LEGA LOT NU. <br />PERMIT 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 />BLOCK � TRACT <br />PARCEL TAX I.D. # <br />PERMIT # <br />��d-� - <br />� 6�-� �v � C� ;.Q �N y �,. �/�d �-�q 1 s s � 5�+ 5 �. �,,i., v, <br />TENANTNAME CONTACTFORPERMIT PHONE <br />���1� y�o�-� ��y My�N�7 �Z�— �� _z�r �. <br />CONTRACTOR f „ j , ']� <br />W v� � <br />CONTR. LICENSE fF <br />USL? OF BUILDING <br />WORK DESCRIPTION <br />j/ S� ADDRESS CITY/ZIP PHONE <br />l.t n,� ����G�- �rwY q(' ��A �y������.� �,� <br />k� 97ti cJ <br />HEATSOURCE <br />_ Electric _ Gas _ Olher <br />�ro__�2 7�r-o7�o <br />� CONTRACT RICE OF WORK <br />30 D C� <br />'r�1 s� 1� ��.�— �i��t �, N���� <br />�r� rG�..� c;�:.�.� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Tuilel <br />Balhlub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Waler heater <br />Sink (service/bar/mo�Netc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Olher <br />NO. <br />s� <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gas range <br />CbUies dryer <br />Range hood <br />Exhausl tan <br />Heat pump <br />Unil heater <br />Boiler <br />Retrigeration <br />Woodslove <br />CITY OF EVERETT LOCAI SALES TAX CODE IS 3105 <br />I hereby ceritity that I have read and examined this applicalion and kn•�w the same to be true and correcL All provisions of laws and <br />ordinaces governing lhis type of worA will be complied wilh �vhclher specified herein or noL The granting oi a pertnit does not presume <br />to give authoriry lo violate or cancel the provision of any olher slale or Iocai law regulating consWclion or the perfortnance af <br />construclion. Thal I am authorized by the owner of this property lo pertorm lhe work for which application is made and I comply with the <br />State Conlraclors La�v 18.27 RCW and 296.200 WAC. <br />� �; �?'�,�j ��� � � 0 6. <br />Signalure o( w edCont od thorized Age � Da e �_ <br />