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SITE ADDRESS <br />SSIs <br />LEGAL LOT NO. <br />PtRMiT 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 />SZ N%' /� <br />%-{'VC <br />HLOCK <br />� <br />J �Fr 4 Sus.av 1:.9���x <br />TENANTNAME <br />CONTRACTOR %�iq-Lr('-�� GA,C'q�.eS�^�� <br />CONTR.LICENSEA ��A-tirGi pcS���J <br />USE OF BUILDING <br />G�A�G�t <br />PARCEL TAX I.D. # <br />vDs bo 30 3 iov�oa <br />TRACT <br />�JbL✓N .�T LL`wt'lL <br />MIT # <br />� / ` O� <br />s>�S 5. 2^'"�t- F�le�,¢rT y2� �Q�U�4S2 <br />CONTACT FOR PERMIT PHONE <br />�o acso.� �Zi s—oy y��'Z <br />ADDRESS Z'7 2b 12.�[re2 CITY2fP PHONE <br />F_.�e�F,T 9az�� <br />yz, zs�-�s�i <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />/L o,v � o <br />_ E�ectric _ Gas _ Olher 1,� � �t�b. OU <br />WORK DESCRIPTION <br />� U! l/� 2 C 4� UA �rCc.C- <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathlub <br />= Lavalbry (wash basin) / � <br />Show.; ' <br />_ Kilchemsink & disobsal <br />Clolhes w�: <br />Waler healc <br />Sink (servia <br />Backllow pri <br />Urinal <br />Drinkin� Foi <br />Floor drain <br />Greasetrap <br />Roof drains <br />Olher <br />NO. I TYPE OF FI%TURE OR ITEM <br />A/C - air handling unils <br />Forced air syslems <br />Gas piping <br />Water heater <br />G s fireplace � <br />Ga range <br />Clolh dryer.- <br />Range �tood <br />Exhaust faii� <br />Heat pump � <br />Unit healer � <br />�oiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I herr.by ceritify Ihat I have read and examined this application and know ihe same to be true and correcL All provisions of laws and <br />ordinaces goveming this type of work will be complied with whether specified herein or noL The granting of a permit does not presume <br />to give aulhority to violale or cancel the provision of any other state or local law regulaling construction or lhe pertormance of <br />construclion. That 1 am aulhorized by the owner of this property to peAorm the work for which application is made and I comply with the <br />S�ate Conlraclq�� 18. 7 RCW and 296.200 WAC. <br />/� � ���L i �6 � ` <br />SignaWre of OwnedContractor/Authorized Agenl Date -`I � <br />� �/ <br />