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SITE ADDRESS <br />� � ( � ��h- �f <br />LEGAL LOTl10, <br />DESC. ) � <br />(P�RMIT APPLICATION <br />CITY �F �'JERE i T PERl1AIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 ����q <br />425-257-8810 - FAX 425-257-8857 - www.everettNa.org �{ �. <br />APPLICATIONS ARE ACCEPTED FROM 8 ANi TO 4 PM <br />PARCEL TAX I.D. # <br />�d,cv'c�� WA• �d�a l 00�97�oDoa7 �ov <br />BLOCK TRACT OR SUB�IVISION # <br />� �- GD <br />� F� EJL"v�-i - l�%�i� <br />P�RMI? # <br />( J `/J �o�. <br />l'��ID,QAUE s FA�M��y �lMrf�'1� �'A�iM�/�SH//' Y9 /G G�t"��kM��,� lNA/�Rysdl��� uJR, <br />TENANT NAME GONTACT FOR PERMIT PHONE %°"' �" �j y <br />/�55 MlO�A/�5 E-MAIL'G�j' Q�dO <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />/ <br />CONTR. LICENSE # � � �� <br />USE OF BUILDING <br />�'F.4.lD�NTI/�L <br />WORK DESCRIPTION <br />HEATSOURCE <br />✓ Eleclric Gas <br />Other <br />l�-;.� � c�, ;�-c �ss ��L� �� :�.�c , � ti S �,�_�„ �- <br />��xd % <br />NO. I TYFE OF FIXTURE OR ITEM <br />% <br />� <br />Toilel <br />Bathtub <br />Lavatory pvash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (servicelbar/mop/etr,.) <br />Bsck(low prevcnler <br />l rinal <br />Drinking Founlain <br />Flaor drain <br />Grease trep <br />Roof drains <br />Other <br />NO. <br />s <br />CONTRACT PRICE OF WORK <br />n� <br />T'!PE OF F:XTURE OR ITEM <br />A!C — air handlinq unils <br />Forced air syslems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />G�s ranc�e <br />Cblhes drycr <br />Rang� hood <br />Exhauslfan <br />Heat pump <br />Unit heater <br />Boiler <br />Re(rigeralion <br />Woods[ave <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify that I have read and examined this applicalion and know the same to be lrue and correcL All provision, of laws and <br />ordinaces yoveming this type of work will be complied wilh whefher specified herein or not The granling of a permil does not presume <br />lo yive authority to violale or cancel the provision of any other stale or local iaw regulating consWction or the periormance of <br />construction. That I am aulhorized by lhe owner ol ihis propeAy to perform the work for which application is made and I comply �vdh the <br />State Gortrectors Law 18.27 RCW and 296200 WAC. <br />,, �/' l i"'r i i'I LU �' �14� l� �% <br />Signature of OwnedContraclor/Aulhorized Agent Date li L <br />