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SITE ADDRESS <br />' `1b� <br />LEGA LOT NO. , <br />DESC. r� <br />OWNER <br />� <br />\ � IC � <br />TENANTNAME <br />CONTRACTOR �, �y' <br />CONTR. LICENSE p <br />��,. <br />USE OF BUILDING <br />WORK DESCRIPTION <br />P�RMIT APPLICATI(3N <br />CITY OF EVERETT P�RMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www•everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�, �>�� �—�� G <br />flLOCK TRACT <br />( ,:.r 5 <br />PARCEL TAX I.D. tl <br />��� 1 �7Y -c;+c� o <br />ICONTACTFORPERMIT <br />ADDRESS ` CITY2IP <br />nL ��( �O^ � � .� l� 1 <br />�C�1v L�I <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathlub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & dispos2l <br />Dishwasher <br />Clothes washer <br />Water healer <br />Sin' '^ervicelbar/mop/etc.) <br />Ba��.dow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease �rap <br />Roof drains <br />Olher _ <br />HEATSOURCE <br />,_ E�edric _ Gas _ Other <br />6 �a-� -� <br />p ITp <br />c) CS 606 ` <br />YMVNC f <br />�J /� d, <br />PHONE <br />� <br />PMONE <br />�/,�S -�7G '//6 <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FI%TURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Ran�e hood <br />Exhaust (an <br />Heat pump <br />Unit heater <br />Boiler <br />Re(rigeralion <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL SALES T/u' COUE IS J105 <br />I hereby ceritify that I have read and examined this application and know the same to be Irue and correcL All provisions of laws and <br />ordinaces governing this lype of work will be complied with whelher speci(ied herein or noL The grenting of a permil does not presume <br />to give authority to violale or cancel the provision o( any other state or local law regulating consiruction or lhe pedormance oi <br />� �nslruction. Thal I am authorized by lhe owner o( this property ro pertortn the work (or which a� plication is made and I comply with tha <br />Stale Contraclors Law 1827 RGW and 29G.200 WAC. <br />- � / • � . : (- "�. <br />