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SITE ADDRESS <br />O� r'.2 fi �` S1' <br />LEGAL LOT NO. <br />DESC. � <br />OWNER <br />MOVni�'S �lnrv� <br />TENANTNAME <br />CONTR. LICENSE # <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.everettv.�a.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />f_ �exa� <br />BLOCK <br />, G�a,, t�d , <br />HT so�v Gh�p�`F <br />RTS <br />USE OF BUILDING <br />PARCEL TAX I.D. # <br />TRACT OR SUB�IVISION # <br />.?NfNi�..;, �y ib <br />CONTACT FOR PERMIT <br />L <br />���hf� c�n <br />�O�i S9� O� �/G <br />7 <br />6 -i�-o� <br />PE�R�JM/IT� #�;�n <br />�__�L/�— <br />jl:C -Gh3 ls(�p <br />Nc F%Lv711 �� I/L' <br />PHONE �/�S y5> SY1.(, <br />E-MAIL Yc�y <br />Y/'LTP PH01 <br />�fa,cY/✓, lIti <br />9817U <br />359 Sf�zc <br />HEAT SOURCE � I CONTRACT PRICE OF WORK <br />SiNbGe F.r.u�•�� ���.�-��i^'J I i�Cleciric_ Ga5_OlhCr I,�/Oo.o,,-c� <br />WORKDESCRIPTION JI<'n�ol:sl� Si..�/�. �-•�� �.�^✓`"d `j""`S�. CJN(pTy�J �/C s/r"+ �<...st <br />o�.�h - Se� /'L�S iiv s/ �< �Ida,�,�w <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />� Toilet <br />BalhWb <br />i Lavatory (wash basin) <br />l Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Cbthes washer <br />W ater heater <br />Sink (servicePoarlmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Foun�ain <br />Floor drain <br />Grease irap <br />Roof drains <br />O�her <br />NO. <br />MtGtiHIVIGHL <br />TYPE OF FIXTURE OR ITEM <br />A/C - air handling unils <br />Forced air systems <br />Gas piping <br />water heater <br />Gas tireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaus�fan <br />Healpump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CIN OF EVERETT LOCAL SAL:S TAX CODE IS 3105 <br />I hereby ceritily ihat I have read and examined this applica!ion and know the same to be irue and correcL All provisions ot la�.vs and <br />ordinaces govemin� this type of work will be complied with whether specified herein or not. The granting ot a permit does not presume <br />to give authority to violate or cancel �he provision of any oiher state or local law regulating construction or the performance oi <br />construction. That I am auR�orized by the owner of Ihis property to perlorm the work lor v�hich application is made and I comply �vith ihe <br />Stale Contractors Law 18.27 RCW and 29G200 WAC. <br />S /g p <br />Date I � <br />Z <br />