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SITE ADDRESS <br />LOT NO. <br />DESC. <br />PE�MIT A,F��LICATI�QN <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 (�-• 30 -0(� <br />BLOCK I TRACT <br />PARCEL TAX I.D. M <br />PERMIT p <br />So(�ub- <br />TENANTNAME I CONTACTFORPERMIT PHONE <br />j �1 u� �1'�ztL) ��:;.� I L,ecv � s k,, r1 fI (JN �— G2 �- 7 T h" ��i— <br />ONTRACTOR ADDRESS CITY2IP PHONE <br />�° �H ,�l�in 5�;�„ Sysr2w5 %'iGi� harc4eson ��r t ver�ryQ.u�/ ��z;-�7c �y.3.� <br />CONTR. LICENSE # <br />13�f rN .Kr� � �c. ,.�-� <br />USE OF BUILDING <br />HEATSOURCE <br />P�Ieclric _ Gas _ Olher <br />CONTRACT PRICE OF WORK <br />'s� <br />WORK DESCRIPTION :.n5/T �l �an G dut ri lq e: � 4-'�EZf $ q� 4y9p ,�'�(j�i�� f'PcQ 6'�+ <br />i I���� �'LiG�i Ci�Utx�qG'�� 3�kgro�n�P �avL�I�R.tcrwzy <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Waler heater <br />Sink (service/barlmop/elc.) <br />Backllow prevenler <br />Urinal <br />Drinkinfl Fountaln <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />NO. ( TYPE OF FIXTURE OR ITEM <br />NC — air handling units <br />Forced alr systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Ranga hood <br />Exhaust fan <br />Heat pump <br />Unit heatar <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y lhal I have read and examined Ihis application and know the samo to be true and cortecl. All provislons oi laws and <br />ordinaces c�overning lhis typo ot work will be complied wilh whether spedfied herein or not The granling oi a permit does not presume <br />to givo authority to vioiat� or cancel the provision of any other state or local law regutating construction or the pertormance of <br />conslrucllon. That 1 am aulhorizod by the owner of lhis property to pe�rrn the work for which application is made and 1 wmply wilh the <br />Stato Conl�actoJs Law 18.27 RCW and 29G.200 WAC. <br />i' <br />� "�_� /=G-�--�-' a / .3� � <br />Sic�nature of wn f onlraclodAulhorized Agenl Dale" �� <br />2 <br />