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SITE AD�RESS <br />5 �2 0 <br />LEGAL LOT NO. <br />DESC. -> -� <br />�1J1)��1P /, <br />TEriANTNAME <br />PE121VIIT 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 />th�ve ��� � G <br />� BLOCK TRACT <br />I C lo� <br />9 <br />. <br />CON7RACTOR L G �ons �'� uc. (�;j .� <br />SPr �� t C p�I L.l �. <br />CONTR. LICENSE # <br />LC�v��c 9_.� +�/ <br />USE OF BUILDING <br />SFQ <br />TAX I.D. # <br />3Loi I,IG� �J <br />CONTACT FOR PERMIT <br />�„ // C�-��CvS <br />l ADDRESS <br />F'/Jl(j �/�i� �'' <br />ds,,l� J.ioG'odc�aN <br />�� <br />/��v��9- 9 <br />F�ERMIT # <br />!/�9:�/ <br />PHONE <br />a� 9 -9vvv <br />PHONE <br />. <<? ��� 24.3'.1�b'S Z �, <br />,.:.: . <br />... <br />CITYIZIP PHO�E <br />C�Zj�, <br />��'��;tt�, � qb z�,,� r: ia S3 � d � <br />HEATSOURCE <br />i <br />_ Electric liGas _ Olher <br />NRKDESCR�JI�� I ; �.:lC � d�I � <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />W aler heater <br />Sink (servicelbar/mop/etc.) <br />Back(low preventer <br />Urinal <br />Drinkinc� Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />�C NTRACT PRICE OF WORK <br />J 3,S �U c� C <br />NO. I TYPE OF FIXTURE OR ITEM <br />/ <br />s <br />A/C — air handling units <br />Forced air syslems <br />Gas pipinc� <br />W ater healer <br />Gas (ireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heal pump <br />Unil heater <br />8oiler <br />Rcfrigeralion <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby cerili(y thal I have read and examined lhis application and know ihe same to be lrue and correct. All provisions of laws and <br />ordinaces goveming lhis type of work will be complied �vith whelher specilied herein or nol The granting of a permil does not presume <br />to qive authority to violate or cancel lhe provision of any olher slate or local law regulating consWction or lhe performance of <br />conslrucfion. Thal I am authorized by the owner o( ihis property lo perform the work for which application is made and I comply wilh the <br />Stale Contraclors Law 18.27 RCW and 296.200 WAC. <br />`�� <br />