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L� <br />SITE ADDRESS <br />. ''_,"'1����-�; <br />LEGAL LOTNO. <br />DESC <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CFDAR STREET, EVERET7, WA 9ti201 <br />425-257-8810 – FAX 425-257-8857 – www.ever^ttwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �—� �.�07 <br />[- v�r.!n �/�:AI <br />BLOCK ' <br />PARCEL TAX I.D. M <br />: �/L:l 7-`I C.`ClJ/�%�lJ <br />TRACT <br />� <br />_...._.. _______ _...._. <br />/� �Iz; 3'i7 CSS� <br />iI�S�[:I�)�-) L.4J�1 /SUC J�q�••.fVII�T /'�V�- �V.i�IJ.�+Ui! �IF:S�J <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />n <br />I���Ji1Nrt�y C l] L..� .�•�P�` ! cl'V-L-�L `ilS lu3 C'07L <br />CON7FiACTOR ADDRE55 CIN21P PHONE <br />CONTR. UCENSE M . TI _ <br />�/l(.i ,�. l� <br />USE OF BUILDING <br />�.,_r� �� <br />HEATSOURCE <br />_ Electric _ Gas_ Other <br />WORK UESCRIPTION��J� <br />� �_L/ / <br />r . . � �� aJ� /��, <br />NO, I TYPE OF FI%TURE OR IiEM <br />Todet <br />BathNb <br />Lavalory (wash basin) <br />Shower <br />KRchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Laundry tray <br />Sink (service/bar/mopletc. ) <br />Back9ow preventer <br />Unnal <br />Dnnkmg Founhain <br />Floor drain <br />Greaca trap <br />Roof drains <br />Other <br />,/ <br />j� ��l � <br />R � `ll <br />�L�.- <br />Z .� x L: �� <br />CONTRACT PRICE OF WORK <br />//� /l��s - <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling uni[s <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas 5repiace <br />Gas range <br />Clotl�es dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refngeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />�� <br />I hereby centify ihat I have read and ezamined this applica0on and know the same to be irue and cortect All prowsions of laws and <br />ordinaces goveming this type of work will 6e complied �wth whelher specified herein or noL The granting of a permit does not presume <br />to give authority to violate or cancel the pmvision of any other state or local law regulating construction or the performance of <br />consVuction. That I am authorized.by the owner of this property to perform the work for which application is made and I comply vnth the <br />State Contractors Law 18 27 RCW and 29G200 WAC. <br />i <br />� <br />- i 1 � �i-�. �� �72� .J <br />Signature of OwnedContractodAuthonzed Agent Date � <br />�� <br />