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� <br />SITE ADDRESS <br />`!'i � I �.� F�� v <br />LEGAL LOT NO. <br />DESC. �j <br />P'tRMIT APPLICATIG��J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEGAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />- � -�-- <br />t•, r L c���_ � i <br />BLOCK <br />PARCEL TAX I.D. # <br />C, � 5�7 ,� 2 v o c� o � 3 c, o <br />TRACT OR SUBDIVISION # <br />� 9��-99 <br />b ' �� <br />OWNER ADDRE55 GIIY/ZIP PHUrvt C�. Z� �}� u��r <br />n <br />.�'�� �1��?J��� 5��-y- i��4�.�, S� Sw' Mu�ci�ico wr� i,Yz�,Y <br />TENANT NAME CONTACI' FOR PERMIT PHONE <br />., ^_��.� ��a Z�33 <br />�� !; t*v I C._C' �-I ;�. r� K�2 r-1 f' '• � n� u <br />. . \ E-MAILriL�'A....sl�`�-J�jclr rl <br />CONTRACTOR � ADDRESS CINIZIP PHONE <br />CONTR. LICENSE # • ' ' � � � � � � ! • . � � • <br />USE OF BUILDING � � <br />�^ <br />�_ �---. .. 1 '1 <br />WORK DESCRIPTION <br />{�1�1;�i i,.�,' <br />IS ���i);tocn�S. <br />• " HEATSOURCE <br />� Eleclric _ Gas _ Other <br />�'., /" i> �� i�< c�o �9�� C� .. c� C� r i^ j t <br />� ,// �' � � <br />NO. I TYPE OF FIXTUR[ OR ITEM <br />% Toilet <br />Bafhlub <br />y_ Lavalory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dish�vasher <br />Clolhes washer <br />Waler healer <br />Sink (service/barlmoplcic.) <br />Backtlow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Olher <br />� <br />CONTRACT PRICE OF WORK � <br />( n-i, i� C ll'e�,., �..a <br />TYPE OF FIXTURE OR ITEM <br />NC — air handling unils <br />Farced air syslems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />qothes dryer <br />Rangr,hood <br />Exhaustfan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify thal I I;ave read and examined this applicalion and know ihe same lo be true and correcl All provisions cf laws and <br />ordinaces governing this type of work will �e complied with whether specilied herein or nol The granling o( a permil does not presume <br />to givr. authority lo violate or cancel the provision of any olher state or locai law regulating conslruction or Ihe performance of <br />conslruction. Thal I am �uthorized by the owner of this property to perform Ihe work for which applicalion is made and I comply wilh lhe <br />Slate Contradors Law iU.27 RCW and 2P6,200 WAC. <br />r'o� �6�0 <br />�Z <br />