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SITE <br />✓c <br />PtRMIT APPLICATIC�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CF_DAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIQNS ARE ACCEPTED FROM 8 AM TO 4 PM <br />- ,, <br />��, � ,t S , �� <br />LOT NO. BLOCK <br />i <br />flf� ffE �/v� �, .-� <br />TENANTNAME <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIV�SION # <br />G-io --d'j <br />PERMIT # <br />> c�tn_ � - v� <br />AODRFSS CITY2IP PHONE t�/z $�- C S J� L_ <br />7 / �' .ni. �� . ft_,.� <br />CONTACT FOR PERMIT <br />�v_.,ol-/ iti7 J`J' '• / <br />PHONE <br />I E-MAIL <br />ADDRFSS � �Z <br />ONTR CTOR S��� ��. c � c�f��^ 5�,i � S G�� '�iY' �/%`/ <br />CONTR. LICENSE # � <br />STAfi�R�/oi.T�✓ �/3/ N, l�c�y s� yxo,�v� v�-�. �r:�z�z <br />USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />-i-t �;., �,C � � <br />_ Electric <br />�" 5 L.,,�) i��, �.�-� <br />NG <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />BalhWb <br />Lavalory (wash basin) <br />Shower <br />Kilchen sinA & disposal <br />Dish�vasher <br />Clolhes washar <br />Water heater <br />Sink (service/bar/mop/etc.) <br />6acktlow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roof dra�rs <br />Othcr <br />Gas _ OII �er <br />�-�..�> �- s y�--�l � , <br />NO. <br />� <br />TYPE OF FIXTURE OR ITEM <br />AIC - air handling unils <br />Forced air syslams <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gasrangc <br />Clothes dryer <br />Ran9e hood <br />[xhaust tan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriliiy thal I have rr�d and examined this applicalion and know the same to be lrue and correcl All provisions of laws and <br />ordinaces c�overning this type of work will be complied �vilh whether speci(ied herein or noL The c�ranting of a permil does not presume <br />to give aulhority to violale or cancel the provision of any otner stale or local law regulaling consWction or the pedormance of <br />construction. Thal'I am authorized by lhe owner of this property to per(orm the work for which application is made and I:,omply with the <br />Slale Contractor� L'aw 18.27 RCW and 296200 VVAC. <br />��0_ <br />