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SITE ADDRESS <br />51y Tu�,4� <br />LEGAL LOT NO. <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 I.D. # <br />� f„ �-. � s �_�� <br />BLOCK TRACT OR SUBDIVISION N <br />/a�Oz-aS <br />PERMIT 1F <br />1 n9i�-�0 <br />�.�, � S-!ra n�, 5 1 y TNMNr � �� �.,� c.rc.� N a ���3 2�c.�9 jo-I c� S lo <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />yZ � �73 ,oso <br />, k s t;� N�`Na 1 �, EalIAIL <br />CONTRACT R - � P <br />�G�V�c�.t ivv�<<-S <br />5o�d jtiw,�„��tc /t..,t f �,�t�k3�3 <br />CONTR. LICENSE p <br />�/t<�..� (- �1 S q�. > P �t <br />USE OF BUILDING <br />1 - d�c.��; <br />WORK DESCRII <br />,1„�r�-�.\1 S v ��.1 z1a�E <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Dathtub <br />Lavalory (wash basin) <br />Showcr <br />Ki�chen sink 8 disposal <br />Dishwash�r <br />Clolhes washcr <br />� Water heater <br />Sink (serviceibar/mop/etc.) <br />Backflow prevenler <br />Urinal <br />DrinY,ing Founlain <br />Floor drain <br />Grease Irap <br />Rool drains <br />Other <br />HEATSOURCE <br />V Electric Gas Other <br />� 2 j`2') �-� O � D <br />CONTRACT PRICE OF WORK <br />qs� = <br />� S��Un � irnr,\ ��al1 U�.L�c,�� �a�vE,��.fn:.nson'��� <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC — air handlin9 unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas (ireplace <br />Gas range <br />Clothes dryer <br />Rangc hood <br />Exliausl fan <br />Healpump <br />Unil healer <br />Boilcr <br />Re(rigeration <br />Woodslove <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 3705 <br />I hereby cerili(y that I have read and examined this application and know ihe same to be Irue and correcl All provisions of laws and <br />ordinaces govemin� this lype of work will be compiied with whelher specified herein or nol. The granting of a permit does not presume <br />lo give aulhority lo violale or cancel lhe provision of any olher slale or local law rec�ulating consWclion or the peAormance ot <br />construction. Thal I am authorized by the owner of this property to perlorm the work lor which application is made and I comply with the <br />Slalc �ntraclors Law 18.27 RCW and 2�Jfi.200 WAC. <br />�C- �� —. v�-_ —� � 0� 2� O <br />