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SITE <br />�ESC. <br />P�RMIT APPLICATiOnI <br />CITY 6F EVERET"T F'ERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIi)NS ARE ACCEPTED FROM 8 AM TO 4 PM <br />2ESS PARCEL TAX I.D. # <br />�v�,o -7 � P�- o0�o�'3a000�s_o� <br />LOT NO. BLOCK TRACT OR SUBDIVISION p <br />C-;-�� 2G � <br />TENANT NAME <br />CONTRACTOR � n � <br />�� <br />CONTR. LICENSE iJ � �/ <br />T< <br />PERMIT# <br />M � r.i ,�, 10 3 0'7 �^ P �. � Jc-�e� r �� �v A <br />CONTACT FOR PERMIT PHONE z�� _� e 3_ �� g& <br />��� FLCZ�G�-��%L E-MAILCABfs�C(�Jl�i)�R� <br />ADDRE55 ��� ����r <br />Cc15T�r�1 Bc.p6S P•� � C3ok f 8 Z7 <br />� L u 6� q q t.� � r� �2�5� , ��s <br />USE OF BUILDING <br />C/k 2- 51"02/•1 G-C� Wo 21c5 <br />HEATSOURCE <br />Eleclric _ Gas _ Other <br />r�zr�3z8 �ja58 ,� <br />�t/A qg2'7-o <br />CONTRACT PRICE OF WORK <br />�i zl�Op� <br />WORK DESCRIPTION <br />2�( `K 3Z� ?C 10 � G�"2q-GL`- c�"� P <br />�J�o p <br />BING <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />�alhtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Waler heater <br />Sink (service/bar/mop/elc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher _ <br />(�oo (= <br />S i !J l n.1 � <br />NQ. I TYPE OF FIXTURE OR I� EM <br />NC — air handling units <br />i Forced air syslems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Clolhes dryer <br />Range tiood <br />Exhaust fan <br />Heat pump <br />Unit healer <br />Boiler <br />Retrigerelion <br />Woodst�ve <br />CIlY OP EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify lhat I have read and examined this application and know the same to be lrue and correcL All provisions of laws and <br />ordinaces yoverning lhis type of work will be complied wilh whelher specified herein or noL The granting of a permit does not presume <br />to give authority to violale or c2nr,el the provision of any other slale or local law regulatin9 construclion or lhe per(ormance of <br />con k� lion. Thal I am aulhorized by lhe o�vner of this property lo pe/r�orm t work (or which applic2lion is made and I comply with ihe <br />SI te �Sunlr clors La�v 1 CW and 29G.200 WAC. „/ / t l <br />! ��� � � � / <br />iynalure o( Ownerl�., ntraclodAuthorized l�geni Date �� <br />� <br />L�' <br />ce.� <br />