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SITE <br />f�tRMIT 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 B AM TO 4 PM <br />(t,ocK�'I�Ge� � v � <br />LOT NO. BLOCK <br />TRACT <br />PARCEL TAX I.D. # <br />9/66SOo; <br />�i -�-a' --s�.6 <br />PERMIT # <br />GuQJfal ArLI,.•�'cc.Ls 1•F13 Rook�e�F�dl�r ave. t►�i�ti 4��.0� 3r7 �o�� <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />Cl�.P ! i�q � /i PC.�'�i �'C�lt S I�� i v�t �{Un't' �i 2�' 7 7! p8d S— <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />�erry N� s�jn 5ys��s5 7900 !}ti�deson (1d �i�}-,,� N2S-7T�•��3,s- <br />CONTR IICENSE # 98�0 1 <br />F3oorH .^l cD T 7G�t <br />USE OF BUILDING <br />a� <br />HEAT SOURCE <br />P�lectric _ Gas _ Other <br />WORK DESCRIPTION �n.S %To � I On G SG <br />O-/l Fj M'c k w e. l f m�F. �"e.L�.w f <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />I<ilchen sink 8 disposal <br />Dishwashor <br />CloUies washer <br />Water heater <br />Sink (service/bar/mop/olc.) <br />Back(low preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />CONTRACT PRICE OF WORK <br />3, 9fo°� <br />�" �.I�w��nv� Let�'ers <br />Qv � lal✓�w9 , <br />ryp, I TYPE OF FI%TURE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />Gas piping <br />W�ler heater <br />Gas lireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unil heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 8105 <br />I hereby ceritify lhat I have road and examined this applicalion and know the samo to be truo and correct. All provisions o( laws and <br />ordinaces �oveminc� this typo of work will be complied with whelhor specified herein or noL The granling of a permil does nol presume <br />lo pive aulhoriry lo violate or cancel the Qrovision of any olher state or local law rec�ulatinc� conslruclion or lhe peAormance of <br />construction. Thal I am aulhorized by the o�vner of this property to penorm the work (or which application is mado and I comply wilh the <br />State Conlraclors Law 18.27 RCW and 296.200 WAC. i <br />� <br />SignaWre of Owner/Conlraclor/Aulhorized Agent Date � ' <br />/� . <br />