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SITE ADDRESS <br />LEG� <br />PERMIT APPLICATI(3N <br />CITY OF EVERETT PERMIT SEFtVICES <br />3200 CEDAR STREET, EVERETf, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS AR': ACCEPTED FROM 8 AM TO 4 PM �j _a. s-0.� <br />�.� PARCEL TAX I.D. # P RMIT� � j _/� <br />,�� 17 ►- zb�'s-kol - 235y_�o2- � r <br />BLOCK � TRACT <br />1('—/�"C E/j-�.%�j �1 �S oL (�I�S � 6 0 5 N I� SA�'�1 �ilSl�� / O � <br />7ENANTNAME CONTACTFORPERMIT PHONE <br />i�y���lG, � yo��l KdrJ cHi�,i �63538i� <br />CONTRACTOR ADDRESS CITY2IP PHONE <br />w� sT coA s-� � r1-v v�r1--� y � z s i g�v c �63 �7 w,�>, ,�✓r�� <br />CONTR. LICENSE # W�- STC P M a�� P o <br />USE OF BUILDING � HEAT SOURCE <br />�S7��r.�T <br />WORK DESCRIPTION <br />�Eteclric ✓Gas _ Olher <br />CONTRACT PRICE OF WORK <br />,•. <br />SSoo' <br />�� O ii� i"-( �.�/ ,r% � (//�'l �3 � ��-7 ,�h �+� <br />G/°OL';v.�j G✓o/'./� �ji� t-Goo/Z Sin�I�s, <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Cblhes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />�rinkinc� Fountain <br />Fioa� d,�, s, N!� <br />Grease lrap <br />Roof drains <br />Other <br />NO. I TYPE OF PIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air syslems <br />Gas pipiny <br />Water healer <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />[xhaust (an <br />fieat pump <br />Unit healer <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know lhe same to be true and correct. All provisions of laws and <br />ordinaces qoveminc� lhis lype of work will be complied wilh whether specified herein or noL The granling ot a permit does not presume <br />to give aumoriry lo violale or cancel lhe provision of any other stale or local law regulating construction or lhe pedormance of <br />construction. That I am authorized by lhe owner of this property lo perform the work for which applicalion is made and I comply wilh the <br />State Contraclors Law 18.27 R�W and 296.200 WAC. <br />,�Z ��� s - z6 -o� <br />