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SITE ADDRESS <br />� 5 �z s i <br />LEGA LOT NO. <br />P�RMIT APPLICATIUN <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'f0 4 PM <br />PAR�EL TAX I.D. tl <br />37X , 57o-ni3-�� <br />i; <br />BLOCK TRACT C . �" <br />S 7U dti.;i J�on �� l� •I. S �� �l -�?.oh��v4>H �✓r.r/ <br />ennaFcs CITY/ZIP PHONE <br />�aos �.sa-i��s <br />TENANTNAME CONTACT20RPERMIT PHONE <br />�..i�'1 � fT� �� Ir �� ke �-L�rS¢* Yis - 3���- ��5 SJ <br />CONTFACTOR AD�R[SS CITY2IP PHONE <br />,1.i;arStfl �o,�,t �1c i-� IIt��A�s �^ �-/03 Ct,iq�2•� 4rSdoSr �1JS�ja1-�535' <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEATSOURCE <br />_ Eleciric � Gas _ Other <br />WORK DESCRIPTION � ", _� <br />�Pv✓�Cc�� � <br />NO. I TYPE OF FI%TUR[ OR ITEM <br />Toilet <br />J_ Balhtub <br />_)__ Lavalory (wash basin) <br />Shower <br />�_ Kilchen sinY. 8 disposal <br />Dishwasher <br />Clothes washer <br />Water healer <br />Sink (service/badmop/elc.) <br />Back(low prevenler <br />Urinal <br />Drinkinc� Fountain <br />Floor drain <br />Grease lrap <br />Roo( drains <br />Olher <br />CONTRACT PRICE OF WORK <br />�$SCY�,°o <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C - air handling unils <br />Forced air syst�ms <br />Gas pipinc� <br />W aler healer <br />Gas fireplace <br />Gas range <br />Cblhes dryer <br />Range hood <br />�_ Exhaustfan <br />Heal pump <br />Unil heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />CITY OF EVERETT IOCAL SALES TAX CODE IS J105 <br />I hereby centify that I have read and examined this application and know the same lo be irue and currecL AC provisions of laws and <br />ordinaces goveming this lype of work will be complied with whether specified herein or nol The greMing of a pemiit does not presume <br />lo give aulhorily lo violale or canccl the provision of any olher sla�e or local law reguialing conslruclion or the performance of <br />consiruction. Thal I am aulhorized by lhe owner of ihis propedy lo perform lhe work for which applicalion is made and I comply wilh the <br />State Contraclors Law 18.27 RCW and 296.200 WA . <br />c_ /1;?%-'�' �:_�% �... 7-j�- o fo <br />Signalure of wnedContractor,'Aulhori��0 Agent Date �/ <br />L <br />