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SITE ADDRESS <br />, �� ��, <br />/':��i I i�! <br />LEGAL LOTNO. <br />DESC. <br />OWNER <br />\_I % <br />TENANTNA E <br />PERMIT APPLICATIQN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 3��-O 7 <br />425-257-N810 - FAX 425-257-8857 - wv�w.everettwa.org <br />APPLI�ATIONS ARE ACCEPTED FROM 6 AM TO 4 pM <br />r. t .i� <br />BLOCK <br />PARCEL TAX I.D. M <br />� �'C'� //� =' i� <br />TRACT <br />' •�,I.I,i (i'•I'1�6'1' 'z ll�l� <br />1117�55 <br />4!i( 7�C 7("> � �1�fIl�L <br />CONTACT FOR PERMIT <br />J��Z"/� <br />PERMIT p <br />C�OiO� C�[ <br />�� Fl,rl�' (1'i /PQY i��0� <br />PHONE /�-�-zLU %G Z�J`; <br />i:x7.i2 �,x�i(:i�!/ 7.�t <br />PHONE <br />.,. :�� I l��k 1 IZ' ��a����:�� '',(�,��, r�,�`�o��;� r` <br />.; �� . <br />CONTRpCTOR ADDRESS CINi7JP PHONE <br />I�Ct��t.i�� I—}=-1it.�� ����-� Zu L�,i�11��.�.��U{(�'i.�-,(•�/��.��_• 3(vc.,tc�li-�'� �'7 <br />CON LI ENSE N - • � . <br />USE OF BUILDING <br />WORK DESCRIPTION <br />NO. <br />� <br />TYPE OF FIXTURE OR ITEM <br />Tailet <br />Ba�htub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (servicelbar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease irap <br />Roof drains <br />Other <br />HEATSOURCE <br />Electric � Gas _ Other <br />/-- �o e <br />NO. I <br />CONTRACT PRICE OF WORK <br />���J��: Ln25 <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas pipiny <br />Water heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Ezhauslfan <br />Heat pump <br />Unil heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVEREIT LOCAL SALES TAX CODE IS 3705 <br />I hereby centify that I have read and examined lhis application and know the same lo be lrue and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied vnth whelher specified herein or not The granting of a permil does not presume <br />to give authoriry to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. That I am authorized by the owner of ihis property to perform the work for which application is made and I compty with the <br />Slate Co ractors Law 18. ' RCW and 296200 WAC. . <br />�'' . � . _ /�c �, ,- - <br />`Iz <br />