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ADDRESS <br />,� ��� s� i <br />L I.OT NO. <br />�9 � � <br />� <br />�ERMIT APPLICAI �ON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX d25-257-8857 — www.everettwa.org <br />APPLIC 4ilONS ARE l�CCEPTED FROM 8 AM TO 4 PM <br />BLOCK <br />�� <br />�be;�S <br />PARCEL TAX I.D. # <br />�OS-� i�i�o6oC� <br />TRACT OR SUBDIVISION # <br />ADDRESS r1 <br />1"� � v y �cl J �d'm <br />s <br />i/-a-�/--�i <br />PERMIT # <br />-�� <br />10NE �� 3�g s? S <br />TENANT NAME � CONTACT FOR PERMI� ��� � 7g _�/�� <br />,�v� '�� ` s ` <br />E-MAIL <br />CON RACTOR ADDRESS CI IZIP PHONE <br />CONTR. LICENSE # ��,-, �Y \Q/ ( <br />USE OF BUILDING S.I U U LE <br />�-� Fu"��Y e � <br />WORK DESCRIPTION <br />�e�1C u� �racl� o�. <br />HEATSOURCE <br />_ Electric _ Gas <br />i�o�s� - I? Ss� j i- <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilcl <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (serviceNadmop/elc.) <br />Back(low preveMet <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Groase trap <br />Roof drains <br />Olher <br />CONTRACT PRICE QF WORK <br />Other <br />N0. I TYPE OF FI%TURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaust (an <br />Heal pump <br />Unit heater <br />Boiler <br />Re(rigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL �ALES TAX CODE IS 3105 <br />I hereby ceriti(y that I have read and examined U�is applicalion and know the same lo be true and correcL All provisons of laws ��nd <br />ordinaces goven inc� this lype of work will be complicd wilh whelher specified herein or not. The c�ranling of a permit does not presure <br />to giae authorit to violate or canc rooision ot any olher slate or local law regulating construction or the peAor.mance oF <br />conslruction. iat I am authori d by th owner of lhis property lo pertorm lhe work for which applicalion is made and I comply with lhe <br />State Con ctors Law CW arcL 96 00 WAC. <br />_ _ � ��� �� //-/7 Oq <br />�/Z <br />