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SITE ADDRESS <br />LOT NO. <br />PERMIT APPLICATION <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. N <br />(��� Ave � <br />BLOCK TRACTORSUBDIVISIONi <br />�� <br />PERMIT M <br />5 ioo�-o� <br />vas� 3a,� .. I a 7 b <br />TENANT NAME �CO_NTACT FOR PERMIT PHONE Hp1,T�-eZ,�- G L' • I <br />Me�l�r� SG(.(.Ivur� J�Vf. ���/v EaAN�/Lw��/L�c.81Qf�.c.a <br />ltiwrS�rk �16Ni 1Nc. � ll} Bvan� p�c Uew1� Yi1��d117-GBo( <br />CONTRLICENSEf ��5� ^,ar�,H�'q8� <br />.. <br />USE OF BUILOING <br />c.,_ <br />� <br />HEATSOURCE <br />_ Electric _ Gas _ Other <br />CONTRACT PRICE OF WORK <br />lS3o <br />WORKDESCRIPTION ���� M�{4l L�}�u'� Zh.�k,lltl k(/ (S'/u.�-�' uf MG-4al f�wclN�. <br />:LN�Talle.� wl-�� 3rc �ftndl. _ i './, <br />� , -.i.��_ . . , � � <br />, , -� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathlub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dlshwasher <br />Clothes washer <br />Water heater <br />Sink (servicelbar/mopletc.) <br />6ackflow preveMer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Greaselrap <br />Roof drains <br />Other <br />3A71 <br />TYPE OF FIXNRE OR ITEM <br />AIC - air handling unRs <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />as range <br />bthes dryer <br />�2ange hood <br />Exhauslfan <br />Heat pump <br />Unit heater <br />CITY OF EVERETT LOCAL SALES TAl( CODE IS 3105 <br />I he�by certi lhal I have read and examined this application and know the same to be true and correct. All provisions ot laws and <br />ordi ances g erning this type of work will be complied with whether specifiecl herein or not. The granting of a pertnit dces not presume <br />to gi e nulhor to violale or cancei the provision of any olher state or local law regulaFng consWclion or the pertormance of <br />conslructlon. hat I am authonzed by the owner of this pmpeAy to peAorm ihe work for which applicalion is made and I compty with Ihe <br />Stale� Conira ors Law 1827 RCW and 296200 WAC. <br />�,, � � �O/D <br />Si aWr � OwnerlContractodAuthonzed Agent Date �/ <br />z <br />