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SITE ADDRESS <br />� � ' �. S <br />LEGAL LOTNO. <br />DESC. � ��i � 'N �1 � <br />OW�NER � <br />/ � <br />i - <br />TENANTNAME <br />CONTRACTOR �, // <br />IbiG-r <br />CONTR. UCENSE N'� ( / <br />I I L <br />U/S�E OF BUILDING <br />!� ' �;.�� I�t \ <br />NORK DESC�RIPTION <br />�,th�n,�--t� <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.evereltwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />/ PARCEL TAX I.p. # <br />"� S � �� � sGf � <br />gI�K TRj CT , � <br />t t� - <br />AD�RESS CINIZIP <br />' l�r� Ac, Cv��1 �1.� <br />'l; j s5 u,Ll�cF <br />ONTACT FOR PERMIT <br />� j / <br />/fN I�LERNi�tO <br />d� <br />"s��� <br />Pl� CrC�- l <br />L' RL�o�' / S <br />��z�- <br />PHONE <br />ir� <br />CITY P PNONE <br />Lv����1,��13 425-.25�1-.� <br />— HEAT SOURCE I CONTRAGT YKI�t vr rrvnn <br />� .Ya�'% � iEj �6�''L� <br />Eleclric � Gas _ Other .. <br />J�G� �-��1 �1�.�-'� ,�� � <br />NO. I TYPE OF FIXTURE OR ITEM <br />� <br />Toilet <br />Bathlub � �� <br />�avalory (wash basin) � <br />Shower � <br />Kilchen sink 8 disposal ,_; � <br />Dishwashcr�, � <br />Clothes washer � <br />� W 3l�TTlSeatotr=-- <br />Sink (service/bar/mop/elc.) <br />Backflow preventer <br />Urinal <br />Drinkinc� Fountain <br />Floor drain„' <br />Grease Irap <br />Roof drains <br />Othcr _ <br />NO. <br />MECHANICAL <br />TYPE OF FI%?URE OR ITEM <br />A/C - air handlinq unils , <br />Forced air systems � � <br />Gas piping <br />1Naler heater�-' <br />Gas fireplace � <br />Gasrange--�" <br />Clothes dryer � � � <br />Range hood� ",� <br />[xhausl fan •"� <br />Hcat pump <br />Unil healer <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAI SALES TAX CODE IS 3105 <br />I hereby centify ihat I have read and examined this applicalion and know th� same to 6e lrue and correcL All provisions of laws and <br />ordinaces governing lhis type o( work will be complied wilh whelher specitir,d hcrein or not. The granling ol a permil does nol presume <br />to give aulhoriry to violale or cancel the provision of any olher state or local law regulating construction or Ihe peAormance of <br />conslruclion. That I am aulhorrzed by Ihe owner ot this property lo per(orm Ihe work tor which application is made and I comply with`� <br />Slale Conlract�skaw 18.27 RCW and 296.200 WAC. <br />� a`� � -�-�,�--a� � a� . � <br />Signaluro ol OwnedConlractor/Aulhonzed Ac�enl <br />����� <br />