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SITE A�DRES5 <br />i .D a, <br />LEGAL LOTNO. <br />DESC. <br />OWNER <br />%� Ge % �S S <br />TENANTNAME <br />FERMIT APPLICATIc)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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. i� <br />�'' ,�� l- 269� -�ol- Z'35`f- o0 2. <br />BLOCK � TRACT <br />CONTACT FOR PERMIT <br />CONTRACTOR � / � ADDRESS CITYIZIP <br />,23 �'/,,'��'4-�,A�L �O-�,rT � f<<Go,vw �r.d� � (� i <br />CONTR. CICENSE p � _ , _ _ _ -� <br />USE OF BUILDING <br />WORK DESCRIPTION <br />D/,� C� /�/�� t�' <br />HEAT SOURCE <br />Eleclric Gas Olher <br />/z-- S• �-�- _/�,-�-/��- -� /�1-�-�-�--,-� � r�. <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitclien sink & disposal <br />Dishwasher <br />Clothes washer <br />Water healer <br />Sink (service/badmop/etc.) <br />Back(Iow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other_, uaY SM��-• <br />s -'�a -o(o <br />PERMIT N <br />PHONE <br />PHONE <br />��j '-3of�L <br />CONTRACT PRICE OF WORK <br />NO. I NPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unit heater <br />Boiler <br />Re(rigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TA% COOE IS 3105 <br />i hereby cerilify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces c�oveming this type of work will be complied with whether specified herein or not. The granting of a permil does nol presume <br />to c�ive aulhorily lo violate or cancel the provision of any olher stale or local law reguiating construclion or lhe performance of <br />construction. Thal I am aulhorized by ihe owner of this property to pertorm lhe work for which app�ication is made and I comply wilh the <br />Slalc Conlrectors Law 18.27 RCW and 296.200 WAC. <br />