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SITE ADDRESS <br />�Z / 7 <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />ptl ve,' � <br />TENANTNAME <br />PErtMIT APPLICATIOIv <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 />,S'� �iT�� ve _ <br />BLOCK TRACT <br />AUURE: <br />�c,��'S �fZl7 S� <br />CONTRACTOR � <br />�y/�,cf>�� ;:/->d.Srr�� <br />CONTR. LICENSE A <br />USE Of BUILDING <br />�'S�P 5 <br />WOFK DESCRIPTION <br />PARCEL TAX I.D. # <br />CONTACT FOR PERMIT <br />� i ( '��� <br />ADORESS <br />, �� / ���,�,��� ,�-' <br />/�+ <br />HEATSOURCE <br />� Electnc _ Gas _ Other <br />��- ,�� y� y-�<„1� <br />NO. I TYPE OF FIXTURE OR ITEh7 <br />_ Toilet <br />_ Balhtub <br />Lavalory (wash basin) <br />Showcr <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (servicc/barlmop/olc.) <br />E3ackllow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease irap <br />Roof drains <br />Olhr.r _ <br />��RMIT # <br />- � ��� �� <br />PHONE <br /><�� �fz)= ��-.� <br />� �r <br />PHONE <br />./� 1�2i �-%7V���ZU <br />CITY2IP,�/ PHONE <br />/��G � �fL>-Z.��%`��/, <br />CONTRACT PRICE OF WORK <br />277�`� <br />NO. I 7YPE OF FIXTURF. OR ITEM <br />A/C — air handling uni;s <br />_ Forced air systems <br />_ Gas pipin� <br />Waler healer <br />Gas fireplace <br />Gas ran�e <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />� Heat pump <br />Unil hcaler <br />Uoiler <br />Refrigeretion <br />Woodslovo <br />Other <br />CIN OF EVERETT LOCAL SALES TAX COOE IS 37G5 <br />I hereby ceritify Ihat I have read and examined Ihis application and know the same lo b�3lrua and conecL All provisions o( laws and <br />ordinaces goveming this type of work will be complied wilh whether specified h�. :,� ur noL Tho granting of a permil does not presumo <br />to give aulhonly ;o violate or cancel lhe provision of any olher state or local law reaulating construction or lhe peAormance of <br />conslruction. That I am authorized by lho owner o( Ihis property to peAorm the work for which applicalion is made and I comply w•dh the <br />Slale Conlracl s Law 18.27 RG1N and 296.200 WAC. <br />� ,�/ � . �7�Z��-- > —/� �� <br />