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SITE ADDRESS <br />/ i �� L>> . <br />IEGAL LOT <br />OESC. <br />OWNER <br />!�s opl, � <br />TENANTNAME <br />PERMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 96201 <br />425-257-8810 — FAX 425-257-8857 — www.e��erettwa.org <br />APPIICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAl( I.D. p <br />�C-- a �3� <br />BLOCK TRACT OR SUBDIVISION p <br />C.� , � <br />ONTACTFC <br />Ga��r/ <br />L c�M sr�-� �t�o -� ��a s R�.� <br />lv2 6�� � <br />USE OF BUILDING <br />����L� <br />R PFRMIT <br />!�'✓�,��� <br />ER T# <br />UU OS UD <br />•?� 1 y�S' �S Z � S ; <br />PHONE .�/1J^ 1- 3 � �f �jy � <br />��w� �.i � i�cir rnunc 7U y� r� <br />.,�� qylc�i-ysr�l/P �j'$-.Z <br />SOURCE <br />Electric Gas Olher <br />WORK DESCRIPTION <br />/Jemo f�e e��s��h�� G�.�c�y-e <br />N0. I NPE OF FIXTURE OR ITEM <br />Toilel <br />Bath�ub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwashcr <br />Clothes washer <br />Walcr healcr <br />Sink (scrvicclbadmo�!/elc.) <br />Backflow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Greasclrap <br />Roof droins <br />Other <br />;c 3b�svo� <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />NC — air handling urnls <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas (ireplace <br />Gas range <br />Clothes dryer <br />Rame hood <br />Exhauslfan <br />Heat pump <br />Unit healer <br />Boiler <br />Re(rigeralion <br />Wuodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TFJC COUE IS ]105 <br />I hereby cerilily that 1 have read and examined lhis application and know the same to be true and correct. All provisions ol la�vs and <br />ordinaces �overnin� this lype ol work will be complied wilh whelher spe�ified herein or not. The grenling of a permit does nol presume <br />lo give aulhority lo violate or cancel Ihe provision o� any other slale or local law regidating conslruction or �he pertormance of <br />construclion. That I am aulhorized by ihe owner of Ihis properly lo perlorm the work lor which applicalion is made and � comply wilh the <br />State Conlraclors Law 18.27 RCW and 29G.200 WAC. <br />