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SITE ADDRESS <br />2�_� - 2 <br />LEGALI LOT NO. <br />PERMIT APPLICATION <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 8 AM TO 4 PM <br />-� Sfi. <br />BLOCK <br />PARCEL TAX I.D. # <br />TRAC70R SUBDIVISION # <br />/�Og <br />PERMIT �% <br />r .%su/ ' <br />.,......,. ,.�„n��� ���.,<�r r.,�n� y7S-�(6b_ <br />D�-�.� e i 1� c�c c_ 2�- 2(s � S�- �c��e�� �./A q�� ( 96Y.6 <br />TENANT NA��1E I CONTACT FOR PERMIT PHONE <br />� / y�1 3 3 8- S'�-1 �-f �i <br />I 'V �.I E-MAIL�LL/�/Z,�/�Lltf��. <br />,q rr <br />itt[aa I:IIT/LIY Y <br />3oz6-t/�' �QOe W S�e �z�o <br />CGNTR. LICENSE f! <br />��� p��o y �3Z �3 c� ���-�� <br />USE Of BUILDING <br />Y�c..�.0 il�3�l�`% <br />WORK DESCRIFTION <br />NO. I TYPE OF FIXTURC OR ITEM <br />Toilnf <br />Bathlub <br />Lavatory (wash b�sin) <br />Shower <br />Kif�hen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />W alcr heatei <br />Sink (service/badmop/etc.) <br />BackOow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grcasc Irap <br />Roof drains <br />Other <br />HEATSOURCE <br />_ Electric _ Gas _ Other <br />0 <br />Yzs"�- <br />333-Sy�{y <br />CONTRACT PRICE JF WORK <br />�Z000•v� <br />NO. � TYP[ OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasranye <br />Clothes dryer <br />Range hood <br />�'xhausl tan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />� hereby cerili(y that I have read and exzmined Ihis application and know lhe same to be true and correct. All provisions of laws and <br />oroinaces goveming this type of work will be complied with whelhar specified herein or not. The granting o( a permil does nol presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />consUuction. That I am authorized by the owner of this properly lo pedcrm the work for which applicalion is made and I comply with the <br />Stale Con}[ectors Law„18.?�I RCW and 296.200 WAC. <br />: ���,-� �'g� O <br />i/ <br />