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SITE ADDRESS ` <br />� r' i/7 <br />LEGA LOT NO. <br />OESC. i�s <br />PE�MIT APPLIGAi�IUN <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 ACCEP7ED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D, q <br />6LOCK I TRACT <br />�-p-oo �/S SiCdrX ,dc�?�� ,l„�,�.n.�� <br />- 2 � _-C7 % <br />°RMIT tt <br />f 7l'� �� <br />�%G�ll L. /YCr-iG��1�C'�� Z.5 •- ��if .S/, .S_C' �2C,� y�S'3SS''3S6/ <br />TENANTNAME I CONTACTFORPERMIT PHONE <br />CONTR. LICENSE p <br />USE OF BUILDING <br />/ �/�K"�-"/n.' (.; <br />WORK DESCRIPTION <br />1 � ADDRESS ' CITYIZIP <br />�7(���,�L__� . • ' �'•' •f . ���.� � <br />,. <br />I — HEATSOURCE I <br />Elocidc Gas Olhor <br />/✓E' a �.' C-f�� �l� ( � <br />�� � �� <br />NO. I TVPE OF FI%iURE OR ITEM <br />Toilol <br />Oalhlub <br />Lavalory (wash basin) <br />Shower <br />Kilchon slnk 8 dis�wsal <br />Dishwashor <br />Clolhas washar <br />Watar hoatar <br />Sink (s�rvica/barlmop/ela) <br />Backflow provenlnr <br />Urinal <br />Drinkinp Fountain <br />Floor drain <br />Groaso trap <br />Roof drains <br />011�cr <br />PHONE •' <br />� r: : <br />CONTRACT PRICE OF WORK <br />�. _ . J <br />N0. I TYPE OF FIXI'URE OR ITEM <br />NC - air handling unils <br />Forcnd alr systams <br />Gas piping <br />Wator haalar <br />Gas fireplaco <br />Gas ranpo <br />Clo�hos dryor <br />Rango hooA <br />Ezhaust lan <br />Heat pump <br />Unit hoator <br />Boller <br />Rulrlgerallon <br />_ Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS NOS <br />I hornby c�ritify Ihal I have road nnd examinoA lhis applicalion and know the samo to bo true enh correct. AI! provisions ollaws and <br />nrdinacos y.�vorning lhis lypo ol work will be complied wilh whe!hor spocified horoin or not. The qranling ol e permil does not prosume <br />lo givo auUionry to violato or cancol lho provision ol any olhor state or local law rogula!ing cons4uctlon or the peAormance ol <br />construclion. Thal I am aulhorized by lhe owner ol lhis property to porform lhe work lor whlch nppllcetion is made and I comply wllh lhe <br />StN� Contraclors Lew 18 27 RCW �nd 296.200 WAC. <br />� <br />/' <br />' ,' ��, f � f� . .- �� L .^r 1: /� '%�._'!:-„� <br />Sic�nalure of Owner/ ontrar.tor/Authorizod Agert —� Date �I <br />2 <br />