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SITE ADDRESS <br />`c- �z� <br />LEGAL LOT N0. <br />PERMIT APPLI�CATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — F.4X 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />3 5 � S7` <br />BLOCK <br />TRACT <br />PARCEL TAX I.D. # <br />/�, �%� �,c � po��t�`y r,�s�;b �b}�- �s �` Sf <br />TENA4T'1AME I CONTACT FOR PERMIT <br />CONTRACTOR <br />CONTR. LICENSE # <br />'a G /� %�r S �- <br />.�1����� <br />USE OF BUILDING <br />/�r'S/� �r9Ce <br />ADDRESS <br />c� ,���SW�vz,�.s� <br />HEATSOURCE <br />Eleclric � Gas _ Olher <br />�ver��f y�d�/ ��sar� �j��- <br />PHONE <br />CITY2IP PHONE <br />�u��rvt �'ab -S 7>•,S�" 21— <br />WORK DESCRIPTION <br />�0t-+.�iada�i0/2. S��cud'�er- o� louS� <br />1_� S'�<cb%/�ze � ,���f" <br />NO, I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Eathtub <br />Lavatory (wash basi�) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/badmop/elc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Fioor drain <br />Grease trap <br />Roof drains <br />Other <br />CONTRACT PRICE OF WORK <br />�%C�D f— <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/G — air handling units <br />Forced air systems <br />Gas pipiny <br />Water heater <br />Gas Tireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit hsater <br />Boiler <br />Refrigeration <br />Woodslove <br />Other <br />CITY OF EVERFTT LOCAL SALES TA% CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same lo be true and correct. NII provisio.s of laws and <br />ordinaces govemin� this type of work will be complied wilh whelher specified herein or not The granting of a permil �oes not presume <br />to give aulhority lo violale or cancel the provision of any other slale or local law regulating consWcUon or the performance of <br />consiruction. That I am authorized by the owner of this property to perform the work forwhich application is made and I comply c�ilh the <br />State Contraclors Law 16.27 RCW and 29G200 WAC. <br />%L.,,?�'�,C�G� % -� �'- 1UZy �. <br />