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f'�RIVIIT APPLiCATI�IV <br />CITY (�F EVERETT PERMlT SERVICES ,. <br />3200 CEDAR STREET, EVERETT, WH 98201 %� <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org / �,O��/ � � <br />� <br />I APPLICHTIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CR�DIT C,4RDS ARE NOT ACCEPTED <br />I SITE AODRESS <br />�; 3� ��L- <br />LEGAL LOT NO.� <br />r I�ti�l . / <br />lur r <br />TENANTNAME <br />CONTRACTOR <br />COMTR. LICENSE # j ���� <br />USE OF BUILDING <br />1NORK DESCRIPTION <br />I .�)�'1.{��. 1�' <br />, t <br />Sf� <br />BLOCK <br />% PLUMBING <br />NO. I TY?E OF FIXTURE OR ITEM <br />L� TOilet "� <br />�Bathtub � � <br />Lavatory (wash basin) i <br />�� Shower <br />?+-- <br />�_ Kilchen s�nk 8 disposal <br />�- Dishwasher <br />z- Clothes washer <br />Laundry tray <br />_ Sink (service/bar�mop/etc.) <br />BackFlow prevenler <br />Urin31 <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Cther <br />PARCEL TAX I.D. # <br />� l Do ;� ��00%�>7ov <br />^TRACT <br />�l ` /Y.'✓�,1 �l �Uic/�'� �ocT. <br />ADDRE35 C <br />i�3z� ��rwr�' ����'y �� <br />CONTACT POR PERM1� T <br />CGC.. � c-t2 j�� �' 9• <br />ADDRESS <br />�325 ,, �� �,�r l� <br />HEAT SI <br />I__ Electric � Gas _ Other <br />^ � <br />���, -� ����i�, �II����� ��,��� <br />PERMIT # <br />I -Iv <br />�L���, �6��76 � <br />PHONE <br />S �� % <br />PHONE <br />� �,�i.r;i`�"i�dC <br />PRICE OF WORK <br />"3 ��C <br />�'v �� <br />MECHANICAL <br />NO. I TYpE OF FI :TURE OR ITEM <br />A/C - air handling units <br />! Forced air systems <br />_L Gas piping <br />%= Water heater <br />� Gas fi�eplace <br />� Gasrange <br />z- Clothes dryer <br />'- Range hood <br />i Exhaust (an ; �� � <br />Heat pump <br />Unit heater <br />Boiler <br />� Re(rigeratio� <br />�Voodstove <br />Other <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 9105 <br />� i' hereb� ceritify that I have read and examined this application and know the same to be lrue and correct. All provisions of laws and <br />ordinaces governing this rype of work will he complied �vith whether specified herein or not. The granting of a permit does not presum2 <br />i, to give authority to violate or cancel the provision ot any other state or Iocal I�w regulating consWction or the performancE of <br />nstruction. That I m authorized by the owner of this property to erform the work for which application is made and I comply with ths <br />� ate Contractors L�u� �8.27 RCW and 296.2D0 WAC. ��/� <br />��/ <br />