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SITE ADDRESS <br />12G� `�iD� � <br />LEGAI. LOi NO. <br />DESC. <br />PERMIT APPLICATION ! � ) � <<;���UJ(� <br />C�TY OF EVERETT PERMIT SERVIC�9r� � <br />3200 CEDAR STREET, EVERETT, WA 98201 AUG 1 H ZOO6 <br />425-257-8810 — FAX 425-257-8857 — www.evareriwa.org <br />_._ _. _ . <br />APPLICATIONS ARE ACCEPTED FRO'M 8 AM T�J 4 PM CITY OF EVEflETT <br />�{�"�r G1 �"Z� � PARCEL TAX I.D. # - 'ERMIY # /9- <br />�% e�" �G� Y��� \2z2oc � c� � I l��l ��c� <br />BLOCK TRACT <br />f�-, ��' � �. <br />� �t;_.c 4lC�.i_r,�. � � � �-l'.0 \"L u�,. "7l.> �V- �c�. .�� �i.;�%-�c-�: <br />TENANTNAME <br />n �-� <br />CONTRACTOR`, /AS��/✓c''�7J ��V.l}%�/` <br />v <br />)L(1 �e.%z �Z-i <br />CONTR. LICENSE A ., , ,. , /� <br />USE OF BUILDING <br />WORK DESCRIPTIUN <br />�� l,�t�.�� <br />FOR <br />�'�'i -Q`'C� <br />L\ �� / „'r " �-�C Il"�l.i �\� � � �l �.� U <br />� ���l�i`N��CITYIZ�P PHONE <br />y� � � I <br />� �rG��� i� <br />l/ �� �'3 �i <br />HEATSOURCE <br />_ Electric _ Gas _ Other <br />`, .�`� � �1 �� � <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavatory (wash 6asin) <br />Shower <br />Ki�chen sink & disposal <br />Dishwasher <br />ClOthes washef <br />Laundry �ray <br />Sink (s.:rvice/bar/mop/etc.) <br />F3ack(low preventer <br />Urinal <br />Drinking Founlain <br />Floor tlrain <br />Greasetrap <br />Roof drains <br />Olher <br />7 � <br />�UL <br />�% 5� �''���,� <br />CONTRACT PRICE OF WO{2K <br />7 :� J --. <br />� v-�l--z`" �ti��,s(-1 2 . <br />NO. <br />� <br />TYPE OF FIXTURE OR ITEM <br />A/C - air hantllfng units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Ran9e hood <br />Exh�ustfan <br />Heal pump <br />Unit healer <br />Boiter <br />Refrigeration <br />Woadstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J705 <br />I hereby ceritify thal I have read and examined this application and know the same to b� true and correcL All provisions of laws and <br />ordinaces governing this type of work will be complied wilh whether specified herein or not. The granting of a permit dues no� presume <br />to give authority to violate or cancel the provision o( any other state or Ioca� law regulating conslruction or the peAormance o( <br />c,ronsVuction. That I am authorized 6y the ovmer of �his property to perform the work for which application is made and I comply with ihe <br />State Contractors Law 1827 RCW and 296200 WAC. <br />� c�. LiJ �l�l;':. � � l� -U'"�,.� <br />Sinnature of O nedContractor/Authorized Agent Date ., <br />