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I�cRMIT APPLICATI <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVE;�ETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE aDDRESS <br />/C // 0 29'y �' �F S� <br />LEGAL LOTNO. BLOCK <br />DESC. 2L� Q,70 Q—O <br />�f���/,/� Q,E��..,E ( % <br />TENANTNAME <br />PARCEL TAX I.D. # <br />R9z8 0000 2yc� <br />TRACT OR SUBDIVISION # <br />H'j�-1'eN �/-+�t'GE <br />/o/% z�1 �'�'�SE <br />CONTACT FOR PERMIT <br />3 -30 -10 <br />PERMIT # <br />lM loD� <br />����r rnvn� -�H'J: <br />6v�>l, wR 9�zo� <br />PHONE <br />� E-MAIL �n w <br />C N A �y/�✓UnI✓Cf �rA�E�./R�/ ADD E yLS-76I—/Gb <br />,iv, c � C 2�2R /��liS iN S'% Gi o` <br />CONTR. LICENSE # ✓��� C�S / ��E� � � / / <br />Stf NQ F. F SC63S9 <br />USE OF BUILDING <br />�'F/L- <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Balhtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (servicelbar/mop/etr,.) <br />Back(low preventer <br />Urin21 <br />Drinkinc� Founlain <br />Floer drain <br />Grease trap <br />Roof drains <br />Other <br />HEATSOURCE <br />Electric /�Gas Olher <br />NO. <br />CONTRACT PRICE OF WORK <br />y3�, -e <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />W ater heater <br />Gas tireplace <br />Gasrange <br />Clolhes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby cerilify lhal I have read and examined this application and know the same to be true and correct. All provisfuns of laws and <br />ordinaces governing this lype o( work will be complied with whelher specified herein or not. The granting of a permil does nol presume <br />to give aulhorily lo violate or cancel the provision of any other state or local law regulaling conslruction or lhe performance of <br />conslruclion. hat I am aulhorized by lhe owner of lhis property lo perform lhe work for which applica6on is made and I comply wilh the <br />State Conl or Law 1827 RCW and 296.200 WAC. <br />��1�, 3-2�-i � <br />