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SITE ADDRESS <br />c�4z-�O �oSc <br />LEGAL LOT�NO. � <br />DESC. � <br />G� <br />TENANfNAME <br />PERMIT APPLICATION <br />ClTY O� 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 i 0 4 PM <br />BLOCK <br />LLG <br />PARCEL TAX I.D. # <br />3t'Q.voc�l�rol <br />TRACT OR SUBDIVISION # <br />�uvia �it,��c d i <br />�2�/�-DE7c- $�f <br />ICONTACT FOR PERMIT <br />l %i GfRey � <br />PHONE L�b'o/g•�¢/3 <br />�� �`O /3cutr R-� D f� E C: <br />CONTRACTOR �VV ^�J� i��1L /7 <br />I3C.uE 2/�XE Co�lST. l'`/�- �� 13o3�3oz %�uvsYcc- � c„ <br />coN�Cc��2C1 `18�c-/�T Lv�• S/9•��Z+3 <br />USE OF BUIL�ING I HEAT SOURCE CONTRACT PRICE OF WORK <br />� <br />Sl=t2- <br />WORK DESCRIPTION �A s' j � <br />� Eieclric _ Gas _ Other � �� z.�' <br />NE'a.) (.�J�o �'�t-�i'rtEt� /o,.���aLrSF <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (�vash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishvrasher <br />Clolhes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />�ack0o�v preventer <br />Urinal <br />Drinking Fountain <br />floor drain <br />Grease trap <br />Roof drains <br />Other <br />l "EiAG//�U) <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />L Forced air systems <br />— Gas piping <br />! Water heater <br />! Gasti;eplace <br />f Gasrange <br />1 Clothes dryer <br />T Range hood <br />6 Exhaust fan <br />Heal pump <br />Unil heater <br />Boiler <br />Reirigeration <br />Woodslove <br />Olher <br />� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerlify lhat I have read and examined lhis applicalion and know the same to be lrue and correct. All provisions of laws and <br />ordinances governing Ihis lype of work �vill be complied �vith whether specified herein or noL The granting of a permit does not presume <br />to give authoriry lo violate or cancel the provision o( any other slate or local law regulating consiruction or ihe performance of <br />consfruclion. That I am aulhorized by the o�vner of lhis property lo perform ihe �vork for which application is made and I comply with lhe <br />State Contrac,Nys�t;nv+ 1827_RCW�� 296200 WAC. <br />� (� <br />