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SITE ADDRESS <br />LOT NO. <br />R <br />IT APPLICATIC�nI <br />CITY OF EVERETT PERMIT SERVICE� <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. # <br />�ii, r�' � ��/G22G�� <br />BLOCK � TRACT OR SUBDIVISION M <br />PERMIT # <br />Z <br />DES0. I I — <br />OWNER ADDRE55 CITYIZIP PHONE js5 �i' <br />�Gl� �/ �i-��% �1� 2� <br />' �v, eox �7 lJ.��rm�,���-z �s� � <br />TENANTNAME CONTACTFORPERMIT � PHONE <br />� g�y� 2��r� �{�-�s-��Ey <br />Tm �va�-,vso,J E-MAIL <br />� <br />�i1�.T�iiZ AUURcaa •••••••••• � -�-�-- � <br />D�; v-n/i �E O�aG- �-fY%v /��iy i3%���. iJ ��,v��� �25_ � �� G yG �l' <br />CONTR. LICENSE � DA�/�..rPl-l-9�! �l�' 4'� ._ ��, � <br />USE OF BUILDING <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />� � <br />Electric �Gas _ Olher � �� ��� <br />WORK DESCRIPTION /1��L�C C �'1S � �l%L GAS f'(i{%✓'J✓�"� (.�� %� ��� <br />�� � sP.qc� oF H��- � <br />�15 F-i-t��v.�e� � C.k'-�-w <br />N0. I TYPE OF FIXTURE OR lTEM <br />Toilet <br />8alhlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Waler healer <br />Sink (serviceNar/mop/elc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. I TYPE OF FI%TURE OR ITEM <br />A/C – air handling unils <br />� Forced air systems <br />Gas piping <br />W ater heater <br />Gas fireplace <br />Gas ranc�e <br />Clothes dryer <br />Range h000 <br />Exhaust fan <br />Hcat pump <br />Unit heater <br />Boiler <br />Refrigeretion <br />Woodstove <br />Olher <br />CITY OF EVERETT IOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify that I have read and examined lhis applicalion and know lhe same lo be lrue and correct. All provisions of iaws and <br />ordinaces goveming this lype o( work will be comp�ied with whelher specified herein or not. The granling of a permit does not presume <br />lo give aulhority lo violale or cancel the provision of any olher state or Iocal law regu�ating conslruclion or lhe performance of <br />construction. That I am aulhorized b the owner of this property to periorm the work tor which application is made and I comply with the <br />Slatc Caf�clors Law 18,2� RC�W ��i ,$96.200 WAC. � � <br />� <br />SigniWce' <br />