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SITE ADDRESS <br />2 7 %/ <br />LEGAL LOT NO. <br />SSiv� <br />F�RMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everetlwa.org <br />APPLICATIONS ARE ACCEPT�D FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # PERMIT # _ <br />�f%��u� �Jv 5/ 68E� 3 9D//o/ o�-, c`> <br />BLOCK TRACT OR S}�8f� SIONf <br />/.� ��'f j�-� iN/�tl-feC.. /�i�l� Li��P CO s% <br />/��� Gv� <br />��.� <br />TENANT NAME COHTACT FOR PERMIT PHONE 1 ��2�j '�3 �_ C� 55�� <br />�p�.�4. `�,c= �,�,.: ,���;, , `i <br />G E•Ma� <br />CO TR C A DRE55 ITYIZIP <br />CONTR. LICENSE N /�)�, JL� <br />C� �v(i <br />USE OF BUILDING <br />sr2 <br />WORK DESCRIPTIUN <br />HEATSOURCE <br />_ Eleciric _ Gas <br />��� <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Balhtub <br />Lavalory pvash basin) <br />Shower <br />Kitchen sink & ciisposal <br />Dishwashc�r <br />Clolhes washer <br />Water healer <br />Sink (scrvicelbarlmop/elc.) <br />Back(low preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grcase trap <br />Roo( drains <br />Other <br />I hereby ccrility lhat I <br />ordinaces goveming <br />lo give authqrity lo vf <br />Slale <br />CONTRACT PRICE OF WORK <br />Olher <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas �ireplace <br />Gas range <br />.,lolhes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit healer <br />eotler <br />Refrigeration <br />Woodslovc <br />CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />rv read and ezamined this application and know the same to be lrue and correct. All provisions of laws and <br />�ype of �vork will be complied with �+�helher specified herein or noL Tne granting of a permil does not presume <br />te or cancel lhe provision ol any olher stalo or local law re ulating construction or the pedormance of <br />authorized by the owner of lhis property to pert m the w rk for which application is made and I wmply with the <br />IR �7 Rf:W and 296.200 WAC. <br />S 2� <br />