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SITE ADDRESS <br />5��5 <br />LEGAL LOT N0. <br />nesc � r� <br />PERiilll�' APPLICATION ,���� a��: <br />CITY OF EVE!RETT PERM!T SERVICES ^ <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettN�a.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM '� ;�� (� ! I' l) I�> <br />l PARCEL TAX I.D. # ,PER� li � ��� <br />`r I <br />q—��.. ���. :�xf)yU► boaaG ssvO �- � �- <br />BLOCK TRACT <br />�,.9 w c�o t) �, R� 5'f'— <br />�� a5 <br />v`�.o�3�,���� ��-�+r,��,uG•S ��.e. 3�c�! co��3y Gut/�f'il �'IS",10 a5�1�I�00C� <br />TENAN7 NAh1E CONTACT FOR PERMIT PHONE <br />l�;t� c..�...o,�..s yas-a�3-S�'SZ <br />CONTRACTOR L L Le u r>T (j�.c:T� u�V <br />si�v��t_S.LLG <br />CONTR. LICENSE # <br />�.c�oN�:.C�Cc��P <br />USE OF BUILDING <br />SF'F. <br />WORK DESCRIPTION <br />C�-•_s,-,iu�r N�:.,..: S�R <br />NO. <br />� <br />PLUMBING <br />TYP[ OF FIXTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavatory (wash b2sin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Wa�er healer <br />Sink (servica/harmop/clr,.) <br />Back(low preventer <br />Urinal <br />Drinking Foun�ain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Ofher <br />ADDRESS � <br />pm(3 y�ol� <br />a5a-� g���.o�qy <br />�.����u-r �t Y;�c� <br />HEAT SOURCE <br />_ Eleclric � Gas _ Othcr <br />CITY/ZIP PHONE <br />L��s—�43—ss��z <br />CONTRACT PRICE OF WORK <br />� �3��,00� <br />NO I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslova <br />Other <br />GIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereGy ceritify lhat I have read and examined Ihis application and know the same lo be true and correcL All provisions o( laws and <br />ordinaces yoveming lhis type of work will be complied with v+hether speci(ied horein or nol The grenting of a permit does nol presume <br />to give aulhority lo violate or cancel ihe provision of any otner slale or local law regulaling consWction or lhe performance of <br />conslruclion. That I am aulhorized by lhe owner of this property to per(orm the work for which applica'ion is made and I comply with lhe <br />State CoNraclors Law 1827 RCW and 296.200 WAC. <br />� 3 �� Ot� �, <br />ato 2 <br />