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SITE ADDRESS <br />`�Z21 3r <br />LEGAL LOT NO. <br />DESC. <br />� <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.oro <br />APPLI �ATIONS ARE ACCEPTED FROM 8 AM TO 4?M <br />BLOCK <br />PARCEL TAX I.D. # <br />TRACT OR SUBUIVISION p <br />i�-a9�o <br />PERMIT # <br />,�lu -u�� <br />UWNtK AUURt55 GI171ZIP PRONE LtL(� '/I jSt�' <br />�o=�F PG�E,vTES 9'ZZ9 ��c� l�� Sc E✓�ye� �y75��Y� <br />TENANTNAME i CONTACTFCRPERMIT PHONE <br />' E-MAIL <br />NTRACTOR ll H �— <br />CON7R. LICENSE # O V✓�/C � <br />USE OF BUILDING <br />HEATSOURCE <br />Fleclric �, Gas _ Olher <br />WORK DESCRIPTION � <br />�Y�SEc�li -�t�-Y v�c�csz. C.� � �� �� �7� �� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilcl <br />6athtub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink R disposal <br />Di;hwasher <br />Clolhes washer <br />Walen c�aler <br />Sink (service/barhnopleta) <br />Back(low provenler <br />Urinal <br />Orinking Fountain <br />Floor drain <br />Greaso lrap <br />Roof drains <br />Olher <br />CONTRACT PRIC[ OF WORK <br />3, SoD <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />Gas piping <br />Water heater <br />Gas (irep�ace <br />Gas range <br />Clolhes dryct <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unit heater <br />Boiler <br />Re(riqeration <br />Woodsl�ve <br />Olher _ <br />CITY OF f:VERETT LOCAL SAIES TAl( CODE IS 3105 <br />1 hereby cerilify Ihal I have read and e<amined ihis application and know Iho same lo be true and correcl A'I provisions of laws and <br />ordinaces c�oveminc� �his rype of work will Le complied with whelher specified herein or noL The granting of a permit does nol presume <br />lo give authority lo violale ur cancel ihe provision of any other state or local law rec�ulating coustruction or Ihe performance of <br />conslruclion. That I am aulhorized by the owner of lhis property to perform the work for which applicalion is made and I compty with lhe <br />Slale Conlraclors Law 18.27-RG\� and 296.200 WAC. <br />�..' <br />( � �c>S E �iE,vTE.S // 2 �r� <br />�-......�.......,,,........,,-...4 ..............�...__.,,,..._. �_._ , <br />s� <br />