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SITE ADDRESS <br />`� I I l'vh11 <br />LEGA LOTNO. <br />DESC. <br />//'i,w <br />TENANTNAME <br />� z <br />CONTR. LICENSE M <br />USE OF BUILDING <br />� <br />PERMIT APPL��ATION <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 />PARCEL TAX I.D. lt <br />BLOCK TRACT OR SUBDIVISION # <br />,�� 2�c�a cv�o,_.e_��� <br />WORK DESCR/IPTION = ' ' ' <br />�/1S , .0 C.77 J'/ �' <br />�� �v' � _ <br />, <br />�ti„r.�rrr � <br />... . ,...,�. <br />ad- <br />�u <br />NO. I TYPE OF FIxTURE OR ITEM <br />Toilet <br />Halhtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Waler heater <br />Sink (service/bar/mopletcJ <br />l3ackflo�v prevenler <br />Urinal <br />� Drinking fountain <br />�� Floor drain <br />Grease lrap <br />Roof drains,�- J � <br />-i� Olher_:-:L� <br />CONTACT FOR PERMIl <br />HEATSOURCE <br />_ Eiedric _ Gas _ Other <br />PERMIT # <br />PHONE <br />PHONE !�� -%3-% <br />'�tJfi��y -�oc�d " s��y �t�d <br />_� <br />CONTRACT PRICE OF WORK <br />I�a w �t � t; °��: <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas pipin5 <br />Water heater <br />Gas freplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heatpwnp <br />Unit healer <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF tVERETT LOCAL SALES TAX CODE IS J105 <br />I hereby certify that I have read and examined this application and know the same to be Irue and correcL All provisions of laws and <br />ordinances goveming Ihis lype of work will be complied with whether specified herein or not. The granting ot a permit does not presume <br />lo give authorily to violate or cancel the provision of any other state or local la�v regulating construction or the periormance of <br />construction. Thal I am authorized by the owner of this property to perfonn ihe work for which application is made and I comply with ihe <br />Slate Coniraclurs Law 1�27 RCW and 296200 WAC. / <br />�I.�z�../;� f% �� /2 �//// �%i <br />_� ' � =�/ / CO.�.,-+ � <br />...__--, _...,._ �..��„��,.,�„�,� ,.�.�� Date <br />�------ -- -- <br />