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PERMIT APPLICAI�ION <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 ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />830 S� l�="���p-l� v�� <br />LEGAL LOT N0. BLOCK� <br />,��Orv c S� �_�'C / <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION # <br />�=;30 _s�-" ��,�P_t��r,a/�way �iOG <br />6 �is-o9 <br />/ 'D/ <br />TENANT NAME CON'fACT FOR PERMIT PHONE <br />pAst-rr �e+er Kvl o�ke�.�-t1. 2«o -$ sb •-7 7� � <br />E•MAIL <br />CONTRACTOR -� AODRESS CITYIZIP PHONE <br />CONTR. LICENSE t!C' `�/ S SLu� _�xO� A�c� j� z�� <br />� <br />USE OF BUILDING <br />WORK DESCRIPTION <br />HEATSOURCE <br />Eleclric Gas Other <br />CONTRACT PRICE OF WORK <br />�/p,00v <br />,�.�.�---¢--���✓-��r.. .. . (`y�rw�`- 2 n a f ( •.r <br />.��� s <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Waler healer <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />I hereby cerilify thal�l have re; <br />ordinaces govGrmng, this lype <br />to give aulhorily lq �i�Qlate or c <br />conslruclion. Thal � a(n a4lho <br />Slale Conlraclots �i�\1��� <br />\ <br />\J `-I <br />N0. <br />TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water heatcr <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unil healer <br />Boiler <br />Refric�eration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX�CODE IS 3105 <br />examined lhis application and know the same to be lrue and correcl. All provisions of laws and <br />c wtll be complied with whether specified herein er not. The granling of a permit does not presume <br />he� provision of any other state or local law regulaling conslruction or the peAormance o( <br />� t�j owner of lhis property lo per(orm lhe work for which applicalion is made and I comply with Ihe <br />%id `2�6200 WAC. <br />�' `� <br />,�Z <br />