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SITE ADDRESS <br />LEGAL � LOT N0. <br />DESC. <br />OWNER <br />TENANT� <br />C �� �`i <br />R � <br />CONTR. LICENSE # <br />USE OF BUILDING <br />F�cRMIT APPLICATI(�IV <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 0 AM TO 4 PM <br />�� � <br />BLOCK <br />� <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION p <br />CONTACT FOR PERMIT <br />a> \\'�ct\ ��t �� �� <br />G i�\�' \��� `� � V.� CI,L <br />��a:`���v.o��Q_ <br />�\1 f: ��riV �I l� <br />o � '�L�-�� <br />HEATSOURCE <br />Eleclric Gas Other <br />WORK DESCRIPTION <br />�`-_}J�C, � �,\ �LI_ � �k-�,�� G�_ <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavatory (wasli basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Waler heater <br />Sink (service/bar/mop/etc.) <br />Back(low prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />NO. <br /># <br />-� <br />PHONE L��.. � j.�/d— <br />e-ma� -SS3" <br />� <br />'� -i-.\ ' \ �-I h-�1 , <br />CONTRACT PRICE OF WORK <br />� <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 fireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher_ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerili(y thal I have read and examined lhis application and know the same to be lrue and correct. All provisions of laws and <br />ordinaces goveming lhis lype of work will 6e complied wilh whether specified herein or nol The granting of a permil does not presume <br />to give aulhorily to violate or cancel the provision of any olher stale or �ocal law regulating construction or lhe performance of <br />construction. That I am aulhorized by the owner o( this properly lo peAorm the work for which applicalion is made and I comply wilh the <br />State Coniractors Law 18.27 R W and 296200 WAC. <br />�•. ��nC�C�\\�i -���\�l� h -�j�'-� % <br />Sic�nalur�SwnedConlractor/Authorized Agent Dale <br />