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SITE ADDRESS <br />��;1z ��� <br />LEGAL LOTNO. <br />oesc. � � v Z �, <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVIC�S <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — �AX 425-257-8857 — vv�vw•everettwa.org <br />APPLICATIONS AR[ ACCEPTED FROM 8 AM TO 4 PM <br />pARCEL TAX I.D. # <br />�����' �3�I �zzoz`7p��S <br />BLOCH TRACT OR SUBDIVISION # <br />�iZ Z , !� G.,i - — -- <br />6 -a�( ��a <br />IRMIT # <br />,00� , <br />OWNER �`�.."- �%� L <br />I ! �� I 2 ��� �'I-K � -4�/L �-(.) f� C �C'K4' �� �vb 713 E� <br />I�ll-t'lL�._� � PHONE <br />TENANT NAME I CONTACT FOR PERMIT <br />�� �,��,�� � S �g''l�✓`� E-MAIL <br />CONTRAGTOR ADDRESS CITYIZIP PHONE <br />CONTR. LIC[NSE # DW I�Z� � <br />USE OF BUILDING <br />�a21�. f = I �N • �l <br />WORK DESCRIPTION <br />�'�'�-� � <br />Np, I TYPE OF fiXTURE OR ITEM <br />Z Toilet <br />I BalhWb <br />�_ Lavalory (wash basin) <br />_L Shower <br />I Kilchen sink & disposal <br />i Dishwasher <br />i Clothes washer <br />Water heater <br />Sink (servicel6arlmop/etc.) <br />Backtlo�v prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease Irap <br />Roo( drains <br />Other <br />HEATSOURCE <br />Eleciric �s _ Other <br />�L 1'� dn o�.�t�G <br />1'RI\.0 v� rvvn�. <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air syslems <br />Gas piping <br />Waler healer <br />� (=�a iueplzce <br />Gas rar�e <br />_L C�olhas dryer <br />� Range hood <br />� Exhaust fan <br />Heal pump <br />Unit heater <br />8oiler <br />� Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined this applicalion and know lhe same to be irue and wrrecl. All ��rovisions of laws and <br />ordinances governing lhis rype ot work will be complied wilh whether specified herein or not. The granling o� a permit does not presume <br />fo give authoriry lo violale or cancel the provision of any olher state or local law regulating consiruction or'ne performance of <br />conslruction. Thal I am authorized by lhe owner of this property to perform the work (or which apalicaliun is made and I:omp�y with Ihe <br />State CoNraclors Lav� 18.27 RCW and 29�.200 WAC. �, <br />�L�c � ��' �.11�'!"� �� ��U/ (i � 1 <br />.^�s� G✓ _ _ / <br />re <br />� <br />