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P�RMiT APPLIt;ATIC.�� <br />CITY OF EVcE2ETT PERMIT SERVICES <br />3200 CEDAR STREE?, EVERETT, WA 98201 <br />�_ f"-' J 425-2.57-8810 - FAX 425-257-8857 - www.everettwa.org <br />I�J <br />APPLIC�TIONS ARE A�CEPTED FRONI 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SI i E ADDRESS <br />? � :C/ <br />LEGA LQT N0. <br />� � 1 /+V��= <br />ALOCK <br />T-r /: l: C� <br />TENANT NA(AE <br />�i� I'�c�r. �j�uCC <br />CONTRACTOR M l.�°.�l,c-A/1i:4 <br />� <br />WARCEL TAX I.D. # <br />TRACT <br />� i` <br />�G �;✓ /��- j'% � � <br />CONTACTFOR PERMIT <br />'`'%(�; f�c,;/� ADORESS /J,U <br />CONTR.LICENSE# ; /C��/�,n� �(�7SNCi�" `�- o"� <br />� � /' <br />USE OF BUILDING <br />HEATSOURCE <br />G v� v� r.T.' �✓�! <br />FHONE <br />� CITY.21P <br />�/.lv�$l(�/r� <br />�J�� <br />,!-�e VC � �a'I% � � _ Electric _ Gas _ Olher <br />WCRK DF.SCRIPTION a� ��� ' <br />/,:�:.,�%;,,�; /'c�;/-r/:-✓/ll� <br />, � <br />NO. I IYPE Of FIXTURE OR ITFM <br />Toilet <br />Balhtub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Disnwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />BackOow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roo( drains <br />Olher <br />PHONE <br />��C, G Si�/i"�� <br />CONTRACT PRICE OF WORK <br />r/"ilim r�- <br />MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling miits <br />Forced air systems <br />Gas piping <br />Waler healer <br />Gas �ireplace <br />Gas ranc�e <br />Clollias dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unil heater <br />Boiler <br />Refrigeration <br />Woodslove <br />Other <br />CITY OF EVERETT LOCpL SALES TAX COOE IS 3105 <br />I I hereby ceritity lhat I have read and examined this application and k�ow the same to be true and corracl Atl pro:isions of laws and <br />I ordinacea governing lhis type of work will be romplied with whelher specified herein or not. The granting of a permit does not presume <br />lo give authurity to violata or cancel the provision of any other state or Wral law regulaling construction nr the performance of <br />c�nslruction. That I am authori�ed by lhe owner o( this property to pedorm lhe work ior which application is made and I com,ly wdh the <br />State Cantrac�ors L�tiu 18.27 f{CW ond 296.200 WAC. <br />