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� <br />SITE ADDRESS <br />����iy �y% <br />I.EGAL LOT NO. <br />DESC. <br />OWNER <br />C � � <br />JGCciC(�t e <br />TEHpNTNAME <br />��.Z <br />T . S���L <br />CONTR. LICENSE p <br />� ��=F� <br />USE OF BUILDING <br />!�� �<r� /%{ <br />�� <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICFS <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 />,� ��c��3��� <br />BLOCK TQACT OR SUBDIVI51 N N <br />�,D-pc'�� /"czirm�'-�i�iti L."'s <br />�//y i�3i�' i��i�/ �i <br />I CONTACT FOR PERMIT <br />i /� <br />, �LLj'�1 Y �- /[ C'// <br />�F:i�— <br />i: �fi� % �!l ��Cr//��' �k� <br />� x� . ._. 'a .� —� �� _ i i <br />HEATSOURCE <br />L � _ Eleclric _ Gas _ Other <br />WORK DESCRIPTION / <br />�, �( �4�t �rz�ir.'��C� ,�'t� �3c���'�zr^<zJ' � <br />,�n� � <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilel <br />8athtub <br />Lavatory (wash basin) <br />Shower <br />Ki�chen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Waler healer <br />Sink (service/bar/mopletc.) <br />BackOow preveMer <br />Urinal <br />Drinkir� Founlain <br />Floor urain <br />Grease Irap <br />Roof drains <br />Other <br />NO. <br />� � - �'Z �"� d <br />PERMIT # <br />> i �}� _p_ <br />'v. N� ,� <br />PHONE <br />/- <br />CONTRACT PRICE OF WORK <br />�� � �i�,C.� <br />TV?E OF FI%TURE OR ITEM <br />A/C — air handling uni�s <br />Forced air syslems <br />Gas piping <br />Wa�er hea�er <br />Gas `; eplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Ex'•aust fan <br />Healpwnp <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TNf COOE IS 1105 <br />I hereby cenity that I have read and examined Ihis application and know the same to be true and correct. All provisions of laws and <br />ordinances governing this type of work will be complied with whelher specified herein or not. The granting of a permit does no� presume <br />to give aulhonty to violate or cancel the provision of any other state or local law regulating construction or the peAormance of <br />construction. That I am aulhorized by the owner of this property to perform fhe work for which application is �aade and I comply wlh �he <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />` l�;l/� y- l3- Iv <br />fi �'/�-��t [ ail <br />Signalure of OwnedContractodA onzed Agent Dale / <br />(Z <br />