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SITE ADDRESS <br />LEGA LOT NO. <br />DESC. ' � � j� _; <br />��,.„:,� � � <br />TENANT NAAAE <br />CONTRACTOR ��} � 1; <br />CONTR. LICENSE i! <br />USE OF BUILDING <br />WORK <br />PtRMIT APPLICATIUN <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. # <br />- -- 005=�6���o5oG� Do <br />BLOCK TRACT . _ <br />'j-.:,J T��,;„ /•.,;y iC i .crc"ji <br />�� � � � , . 1 t � '�'I D � " �i� { l C � ., , ., .� � <br />,�1 <br />CONTACT FOR PERMIT <br />; �-'— i G <br />-- , . „ i� i, � <br />� ADDRESS � CITYlZIP <br />� / � <br />J c�� ,1 ; icH - / •:� �� <br />-� ��/-'�� � -� //,� � � L �.. � �� S �7 . � 1 '. . <br />r'! ✓Y 1 .� i . . . <br />. , %� -)�:� I r <br />Np, I TYPE OF FI%TURE OR ITEM <br />Toilel <br />Balhlub <br />Lavatory (wash basin) <br />_ Shower <br />_ Kitchen sink & disposal <br />Dishwasher <br />Cbthes washer <br />Water heater <br />Sink (service/bar/mop/elc.) <br />8ack(low prevenler <br />Urinal <br />Drinking Fountain <br />F�oor drain <br />Grease trap <br />Roof drains <br />Olher <br />� <br /># <br />-, <br />/-1Zf'-1 i . !:' . � <br />PHONE <br />f-,2 s 9-;�� 6 z <br />PHONE <br />� <br />ysr,� .�'��.;_� ht• <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />_ Electric _ Gas _ Other � ,!�' '� j / ,�� � � <br />� <br />r , . . :;�. . . <br />� <br />�� � � <br />/. . . i — <br />. �. � � � � •� � . <br />uonueuinnt <br />.�_ ��,r+� <br />��' ' , �i. <br />�r,^✓�� . (.,-,,, <br />/�i� <br />�0 � � / � <br />IGr�I�u�UJ� <br />��� <br />NO. I TYPE OF PIXTURE OR ITEM <br />NC — air handling units <br />_ Forced air systems <br />_ Gas piping <br />W aler heater <br />_ Gas fireplace <br />_ Gas range <br />_ Clothes dryer <br />Range hood <br />Exhausl fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT IOCAL SALES TAX CODE �S 3105 <br />I hereby ceritify thal I have read and examined this applicalion and know the same to be lrue and correcl. Ail prcvisions of laws and <br />ordinaces goveming this lype o( work will be complied with whether specified herein or not. The yranting oi a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construclion or the peiormance of <br />construction. Thal I am aulhor'zed by lhe owner of this property to perform the work tor which application is made and I comply with the <br />Sta�e Coniractors Law 18.27 RCW and 296.200 WAC. <br />�= s i�?-O�v <br />SignaWre of OwnedContractor/Authorized Agent Dale �/ <br />Z <br />