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SITE ADDRESS <br />LOT NO. <br />P�RMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-4857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK <br />1�, <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION # <br />C�7 <br />� .-�o --o> <br />U��oB -007 <br />I� G�70�' - <br />IYJ7U�S CYJ2 <br />PERMIT 8 <br />GI�rEi:AnO �-,bH'�E$ rNc i�o fJaX �'�lb� Gk- S7r"flc:vnS,UJF �L1� �izS �3S(,-%i�'7 <br />TENANT NAME I CONTACT FOR PERMIT PHONE ys� 7 <br />�2 �%2S 7� 7 <br />Sl`lX= �✓i�1,��5 E•MAIL <br />R S / <br />/_AKFu��� 1-�,,�,�r -�,�� <br />CONTR. LICENSE # ���� ��� � oa i 3 L <br />USE OF 6UILDING <br />S�� <br />WORK DESCRIPTION <br />C�`!�t S�T�u GTi 0�'� ��= <br />N0. I TYPE OF FI%TURE OR ITEM <br />HEATSOURCE <br />Eleclric � Gas _ Olher <br />CONTRACT PRICF OF WORK <br />ZO�S'% 4✓ ��� �i <br />S"-r�- �'Ft�ic j3� <br />�� Toilcl <br />,�_ Bathtub <br />� Lavatory (wash basin) <br />_�_ Shower <br />J_ Kitchen sink & disposal <br />_L. Dishwashcr <br />� Clo�hes washcr <br />� Waler heater <br />Sink (service/badmop/elc.) <br />�ackllow preventer <br />Urinal <br />Drinkinc� Founlain <br />Floor drain <br />Grease Uap <br />Roof drains <br />_ Olher / <br />— � <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C – air handling unils <br />�Forced air systems <br />Gas piping <br />�_ Water heater <br />1 Gas (ireplace <br />�Gas range <br />Clo�hes dryer <br />Range hood <br />` Exhauslfan <br />Haat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />Olher � <br />CIN OF EVERETf LOCAL SALES TAX CODE IS 7105 <br />I hereby ceriti(y ihat I have read and examined Ihis application and kno�v the same to be true and correct. All provisions of laws and <br />ordinaces governing Ihis type of work will be complied wilh whelher specified herein or nol. The granting of a permit does not presume <br />to �ive authoriry to wolale or cancel Ihe provision of any olher slale or iocal law regulating construction or the performance of <br />con;truclion. That I am authorized by the owner of this propeAy to pedorm Ihc �vork for which application is made and I comply wilh the <br />State Contractors Law 18.27 RCW and 29G.200 WAC. <br />—'�-�.> � ti � �.�7G�(r"% <br />