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SITE ADDRESS <br />(r-/L <br />LEGAL LOT N0. <br />PERMIT APPLICATION <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 />57�-�c S� <br />I BLOCK <br />PARCEL TAX I,D. # <br />OOS� SLl�bo Z7oo <br />TRACT OR SUB�IVISION # <br />�Sl�/ �✓�-J� 4�ufi� 56Zo/ <br />PERMIT # <br />Cu`�t�l-ovcl <br />Yls'-zs3•5o�8 <br />TENANTNAME / CONTACTF,O/RPER/MIT PHONE t.JyS= LS3^SO/H <br />Gr�S I��S�✓ Gr��/toO�S�✓ E-MAILCs/fO0IS1SO1/C/120M.� <br />A S I / IP <br />yOMG fiid dC� <br />CONTR. UCENSE p <br />USE/ OF BUILDING A <br />%5r7�✓• /)G/7OC�� <br />WORK DESCRIPTlON <br />��s�� � ���t�� <br />N0. I TYPE OF FIXTURE OR ITEM <br />Y <br />C <br />Toilel <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Waler healer <br />Sink (service/barlmop/etc.) <br />Back(low preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease Irap <br />Roof draqinsA <br />���1Cf �'ILr �K 4 �.�✓<tl1 �I� <br />J <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />_ EleGric _ Gas � Other <br />� �� "7`��r <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 />Gas fireplace <br />Gas range <br />Clothes drycr <br />Ran�e hood <br />Exhaust(an <br />Healpump <br />Unil heater <br />Boiler <br />Refrigeration <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y lhat I have read and examined this applicalion and Anow lhe same to 6e true and correcl All provisions of laws and <br />ordinaces c�oveming lhis type of work will be complied wilh whelher specified herein or not. The granting of a permit does not presume <br />lo {�ive aulhorily to violale or cancet lhe provision of any olher slate or local la�ti� regulating consiruction or Ihe peAormance ol <br />construction. That I am authorized by lhe owner of this property t� perform the work for which applicalion is made and I comply with the <br />Slale Conlraclors Law 1627 RCW and 29G.200 WAC. <br />�K /,S�x.,iH- h'•8-� <br />