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SITE ADDRESS <br />�'t0� <br />LEGA LOT NO. <br />DESC. � _ y <br />MIT �4PPLICATIUN <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 />PPPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK I TRACT <br />�L �( <br />PARCEL TAX I.D. il <br />oou�4Bz <br />PERMIT # <br />� �'�0 -GO <br />��(/�l n��CiGrc( 3�(0� �VGICt�IL. j�U�i/�� _ <br />TENANT NAME � CONTACT FOR PERMIi PHONE <br />CONTRACTOR ��� �L ��-r i/ C����z�A�_ � ADDRESS <br />� 13UX I �/ �( <br />CONTR. LICENSE p <br />USE OF BUILDING <br />S�-�L <br />HEATSOURCE <br />Eleclric _ Gas _ Other <br />CITV2IP PHONE <br />���.�tE- �z, Z� y-�zsz, <br />I CONTRACT PRICE OF WORK <br />'�TV j � � <br />WORK DESCRIPTION / l %�� �/ <br />�����1� C-G-�G.-'4-�C�t� l.l.�l�l-F /-�}'� Qi� `--�C��_ <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilet <br />Bathtub <br />Lovalory (wash basin) <br />Shower <br />Kitchen sinY, 8 disposal <br />Dishwasher <br />Clolhes washer <br />Laundry Iray <br />Sink (serviceNadmop/elc.) <br />Backilow preventcr <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Olher <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air ha�dling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Cblhes dryer <br />Range hood <br />Exhaustfan <br />Heal pump <br />Unil heater <br />Boiler <br />Re(rigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examine.i lhis applicalwn and know Ihe same lo be trve and correcL All provisions of laws and <br />ordinaces governing this type of work �vill be complied wilh whether specified herein or noL The granting of a permit does not presume <br />to give authonly to violale or cancel Ihe provison of any other stato or local law regulating constniction or lhe performance of <br />construction. Thal I am authorized by lhe owner of this pmperty to perform the work for which application is made and I comply with the <br />State Con�ract faLaw 1 27 RCW and 296.200 WAC. <br />�` � �l/C-.i. _ ��1-�%�OS <br />S��Ture of Owner onlractodAuthonzed Agen� Dalc <br />��2 <br />