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SITE ADDRESS � <br />%<<'�i <br />LEGAI. LOT NO. <br />DESC. <br />OWNER � ! <br />�� i / �' i �/ � v � /, <br />TENANT NAME <br />PERMIT �lPPLICATI4N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-88 i 0-- FAX 425-257-8857 — www.evereltwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�cf ��� � d �.. <br />BLOCK <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION # <br />/ .. ..__..___ / <br />� ( <: Fl /�'v=i i, r //� ,: GG-; <br />CONTACT FOR PERMIT <br />Gf*� �jo `/ <br />/ <br />CONTRACTOR '� � <br />L%'i?;�/l'i�� ��'!<�ii>y' <br />J <br />coNrR. uceHse a � -C-�//'D�/ 9�i1 ��� �i <br />USE OF BUILDING ��- <br />/' s,:/ <br />a� <br />•J � �/ l� �? �i /• C. <br />,Llu Ei����t� ac . <br />HEATSOURCE <br />_ Electric � Gas _, Other <br />�-�o-�� I <br />PERMIT # <br />���' ? � _ �— I <br />�.-Gt/�t".ic1 U//l /�'�0�'� �I <br />WORK DESCRIPTION <br />[',ri�S ✓,�•vc �JC!S �l�rhGr-.f> <br />�-I,l,;y i�% Cf��L�"C-C��'�%' �� �/ P <br />ri <br />PLUMBING <br />NO. I TYPE Of FIXTURE OR ITEM <br />Toilet <br />BathLib <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water healer <br />Sink (servicelbadmop/elc.) <br />BackOow preventer <br />Urinal <br />Drink�:�g Fountain <br />Fic,,r drain <br />Grease trap <br />Roof drains <br />Other _ _ <br />PHONE I <br />��''� 'j��/.� rI <br />, �_ <br />E•MAIL � <br />PHONE <br />�Ei l t,� �`� 3, F�_' � <br />CONTRACT PRICE OF WORK <br />j� .'C'� C.J <br />NO. I TYPE OF FIXTURE OR ITEM <br />f i NC - air handling units <br />Forced air systems <br />Gas piping <br />Waten c�ater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range t�ood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerihfy thal I have read and examined this applicalion and know the same to Ge true and correct. All provisions of laws and <br />ordinaces yoveminy lhis rype of work will be complied with whether speci(ied herein or not. The granting of a permit does nol presume <br />lo give authority lo violate or cancel lhe provision of any other stale or local law regulating construction pr the performance of <br />constructior�/fhat I am aulhorized by lhe owner o( this property lo periorm the work for which application is made and I comply with lhe <br />S�ale Cq2i�Glors Lav+ 18.27 RCW and 296200 WAC. <br />rr/L:_==--�--- �J/ _..3�> �?�' A" <br />