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SITE ADDRESS <br />y9o2 s� 6 <br />LEGAL LOT NO. <br />oesc. Z <br />OWNER <br />�����+ <br />TENANTNAME <br />: . <br />CONTRACTOR ��7 <br />P�RMIT APPLICATIC3iV <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 TO 4 PM <br />ze <br />BLOCK <br />�� <br />I PARCEL TA7t I.D. If <br />i �Oy17�1-000 - c <br />fRACT <br />� P r2�z o � � <br />ICONTACT FOR PERMIT <br />!� � <br />C���.� �N� ADDRESS <br />CONTR. LICENSE #� n�� n T <br />u �� <br />USE OF BUILDING <br />st= r� <br />WORK DESCRIPTION <br />�v5/or�: <br />�, f-� /Q, <br />Np, I TYPE OF FIXTURE OR ITEM <br />Toilel � � <br />Bathtub <br />Lavatory (wash basin) - <br />Shower: <br />Kitchen sink & disposal �� <br />Dishwasher _ <br />Clothes washer ` <br />Waler hnater <br />Sink (servicelb2r/mop/etc.) <br />BackOow preventer <br />Urinal <br />Drinking Fountain <br />Floor dra�n <br />Grease trap <br />Roof drains <br />Olher <br />CITY2IP <br />P, � � ��K 6y , <br />� 'mi�,�'1f� <br />HEATSOURCE <br />_ Eleclnc �Gas _ <br />Olher <br />� .�(.-�` <br />FERMIT # <br />t7 �l?� � ' � � <br />PHONE v�s� <br />�� Siy .32� <br />PHONE <br />PHONE <br />.. ��s <br />��G iio y <br />CONTRACT PRICE OF V/ORK <br />D doG � <br />NO. I TYPE OF FIXTURE �R ITEM <br />� FVC—airhandlingunits <br />�Forced air systems <br />Gas piping <br />� Waterhealer <br />� Gas fireplace <br />� Gas range � <br />� Ciothes dryer � <br />/ Ran�e hood• <br />�Exhaustfaro' <br />Heat pump <br />� Unil heater <br />j� 6oiler <br />_� Refr�eralion <br />/ Woodstove- <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this applicaGon and know the same to be true and correcL All provisions o( Iaws and <br />ordinaces goveming this type of work will bo complied with whelher speci(ied herein or not The granting ol a pertnil does nol presume <br />to give aulhoriry to violate or c2ncel the provision of any other state or local law regulalinc� conslruction or lhe performance of <br />conslruction. Thal I am aulhorized by ihe owner of this property to pertorm the work for which application is made and I comply wilh the <br />Slale CoNraclors Law 18.27 RCW and 296200 WAC. <br />-y a <br />