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SITE ADDRESS <br />LOT NO. <br />�� �3a <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 />PARCEL TAX �.D. # <br />BLOCK TRACT OR SUBOIVISION # <br />r�'7 �7'PC:;eI[I �5T <br />C�U <br />PERMI7 # <br />- �7 `/zs� � �o - �.2 <r � <br />Siiunc�V��U Contf ci<fS 1-�c Y•G �uK �`(3 Lv�f-F i°iz13 <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />E-MAIL <br />T A TOR 1z <br />�undv�eu ��ntrcctorS �.u. 3ax .�u�t3 �uvcr-� S&1�3 yu-g��'�1v7 <br />CONTR. LICENSE # , , <br />USE OF BUILDING <br />�,ArcSc <br />WORK DESCRIPTION <br />�Zju�lcl � cfa; GARye <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathlub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/barlmop/etcJ <br />�ack9ow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Gmase trap <br />Roo( dr2ins <br />Other <br />SOURCE <br />_ Elec�ric _ Gas _ Other <br />CONTRACT PRICE OF WORK <br />� �CJ� OU G <br />%9i S'��� - <br />NO. I TYPEOFFIxTUREORITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />� Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit hea�er <br />Boiler <br />Refrigeralion <br />Waodstove <br />Olher <br />CIN OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />I hereby certify lhat I have read and examined this application and know the same lo be true and wrrec�. All provisions of laws and <br />ordinances governing this type of work wil� be complied with whether specifed herein or not. The grenling o( a permit does not presume <br />to gi"^ �uthority to violate or cancel the provision of any othr,r state or Iocal law regu�ating construction or ihe peiformance oi <br />constn.c,�,.... i'�at I am authorized by the owner o(ihis property to perform ihe work forwhich application is made and I compiy with lhe <br />S�ale Contractoi.. Law 18.27 RCSN and 296200 W�C. <br />/,/6//J� � %- /2 -2a/U <br />Signalure of C�vner/Coniractor/Authorized Agent Date l�Z <br />