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SITE ADDRESS <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />TENANTNAME <br />,l���i' <br />P�RMIT 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 ACCEPI ED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. N <br />s��r: r I <br />BLOCK TRACT OR SUBDIVISION M <br />CONTRACTOR�• � � -_ <br />.Sf���%,,���;�t-� <br />CONTR. LICENSE N � _ <br />USE OF BUILDING <br />CONTACT FOR PERMIT <br />PHONE <br />X <br />/ `1 %/G� �`/�/�/�<%—;G�� G%.;'� cl�:�di�/c� k�`t �J�� <br />i� y�--yd�3-�6E6� <br />HEAT SOURCE � CONTRACT PRICE OF WORK <br />Electric Gas Other <br />WORK DESCRIPTION / <br />� � L-:l I t� ' J r.�J'f" ` n� �d �l)1�zn��Y <.:�.��r� Lc:i���ol <br />,'7�G'Mc�i.�_ , '.S /\., s�,n( C � l, ♦ ` ✓ / i <br />J <br />;��.� /'1'� _-/y � �.G1��.�� � -J-.'1���� ��) <br />n. ...���..� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />6alhlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Waler hea�er <br />Sink (survice/bar/mop/elc.) <br />Dackllo�v prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grcasc lrap <br />Roof drains <br />Olher __ _ <br />i <br />CMy �cr:�rCJi�.l <br />NO. I TYPE OF FDCTURE OR ITEM <br />A/C - air handling unils <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas firsplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhaust (an <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />CITY OF EVERETT IOCAL SALES TAX CODE IS 9105 <br />I hereby cerilify thal I have read and examined lhis applicalion and know the same to bo true and correct. All provisions ot laws and <br />ordinaces c�overning this lype o( work will be complied with whether specitied herein or noL The granting of a permit does not presume <br />to give aulhoriry lo violate or cancei Ihe provision of any olher slale or bcal law regutating construction or the pedortnance oi <br />construclion. That I am aulhorized by the owner of ihis pmperty to per(orm the work for which application is made and I comply with the <br />Slalo Contraclors Law 78.27 RCW and 296.200 WAC. <br />