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SITE ADDRESS <br />JQ I W, r rI <br />LEGA LOTNO. <br />NAME <br />I <br />PtRMIT APPLICA,iION <br />CITY OF EVERETT PERM17 �ERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — wuvw.everettwa.org <br />A„� <br />� ,. <br />JAnr., �„irv�'',/.• �rc. <br />CONTR. LICENSE il <br />'TQIJR1011�A <br />USE UF BUILDING <br />S Y_ f�. <br />WORK DESCRIPTION <br />�:1Y L <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />BLOCK TRACT OR SUBUIVISION M <br />ADDRESS <br />—�(J � WGrmo�[ �iv� F, <br />CONiACT FOR PERMIT <br />/ J <br />' G^!.p („I���r✓�:'.n <br />is9as G�.,,��I, Ra <br />NO. � TYPE OF FI%TURE OR ITEM <br />Toilel <br />Batlitub <br />Lavatory (wasli basin) <br />Shower <br />f(ilchen sink 8 disposal <br />Dishwasher <br />'I Clothes washer <br />�,_ Water healer <br />Sink (servic�/La:/mop/etc.) <br />Backllow prevenler <br />Unnal <br />Drinkin� Founl�in <br />Floor drain <br />Grease Irap <br />Roof drains <br />Olher <br />� CC�`�'- U I i <br />PERMIT p <br />,(r[i� �!� ao6 -va.o- is;s <br />PHONE ��6-�+an-is>; <br />oc E-MAIL .1o.,.,G,�+rc�,..Q�no:�. <br />Z`1iYl P <br />�„�b�.�.,�, 9�a9c aoG �4��J- �s71� <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />Fledric _ Gas _ Olher <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 />Clolhes dryer <br />Range hood <br />Exhaust fan <br />lieal pump <br />Unit hea�er <br />Boiler <br />Refrigeralion <br />Woodstove <br />Other <br />CITY OF EV ERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ccrtify that I have read and examined �his applicalion and know the same lo be lrue and wrrect. All pwvisions of laws and <br />ordinances goveming lhis lype of work will be complied with whelher specified herein or not. The grantin� ot a permit does not presume <br />to give authority to violale or cancel Ihe provision of any olher slate or local law reguiating conslruction or Ihe periortnance oi <br />construclion. l�hal I em authori:.ed by lhe owner of Ihis property to peAorm thr, work for which application is made and I comply with the <br />Slale Contraclors Laiv 18.27 RCW anA 29G.200 WAC. <br />, _. <br />- • 2-�'� 7-1y-l0 <br />...'__...__ _......_'"�n....�.....�...in.a�....��..a n...,.d (lnln <br />