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SITE ADDRESS <br />��c ,.l � <br />� �� , <br />LEGAL LOT NO. <br />DESC. � � <br />�tRMIT APPLICATI(�N <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. # <br />�C)`i`+ Y� CocO'1E00 <br />BLOCK TRACT <br />� I�:,' �.�(; r, f�li ,. �!n.�, ;i�.t , <br />TENANT NAME I CONTACT FOR PERMIT <br />l I:,-a �,�c Ilc ' <br />CONTRACTOR ADDRESS <br />:�tIL�iS i: �`.r_�'�.,n ,..,.�.i�s,��v. J°la CcL,.�dvC. <br />CONTR. UCENSE M.� � �; F �.� �-.�• i Ul <br />USE OF BIIILDING <br />;i�. _ . . i,,- , <br />WORK DESCRIPTION <br />jl.J.:�,� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposa� <br />DishwasheJ <br />Clothes w�sher <br />Walerhq ter <br />Sink (service/badmop/elc.) <br />Backflow preventer <br />Urinal <br />Drinkint� Fountain <br />Floor drain <br />Grease Irap <br />Roo( drains <br />Olher __ <br />j ;c �� �I <br />CITY2IP <br />l��r�[�{ �1ia01 <br />HEATSOURCE <br />_ Electric _ Gas _ Olher <br />�Cn��lo <br />NG. I <br />-zy-o� <br />PERMIT # <br />R,oG�ol-ull <br />n�1�� j�; 75'1-7537 <br />PHONE <br />� ; JSH �537 <br />I�- <br />PHONE <br />�i?5 aYS.FOS'1 <br />CONTRACT PRICE OF WORK <br />� G 2�j U � <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater/ <br />Gas firepia <br />Gas rang <br />Cbthes ryer <br />Rang ood <br />Exh usl fan <br />Heat pump <br />Unit heater <br />Boiier <br />Refrigeration <br />Woodslove <br />Other <br />CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify Ihat I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governinc� Ihis type o( work will be complied with whelher specified herein or nol Tho 9ranting of a permil does not presume <br />to give authonty to violale or cancel the provision of any other state or local law regulating conslruction or tha pedortnance of <br />construclion. That I am aulhorized by the owner of ihis property lo periorm the work for which application is made and I comply with ihe <br />Slate Contraclors L2w 18.27 RCW and 296.20D WAC. <br />. .. ,`/,� `._ ..,�" �F7 <br />Signalure o( OwnedConlncrodAuthorized Agent Date �/ <br />Z <br />