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SITE ADDRESS <br />LOT NO. <br />DESC <br />PERMIT APPLICA�ION <br />CI7Y OF EVERETT PcRMI�' SERVICES <br />3200 CEDAR STP.EET, EVER�TT, WA 98201 <br />425-�57-8810 — FAX 425-257-885i www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO �i PM <br />� �� <br />BLOCK <br />TRACT <br />PARCEL TAX I.D # PERMIT # � ^ <br />_ '�% ���-��_ <br />�� � n—�_-} 1_�e. �It� z�� �i ��.fi /���z � ��.��.ti l�V� `� � �'�G i <br />TENANT NpME' CONTACT FOR P MIT PHONE <br />��l � � �et�ilr.C'� � 1�(`«� �� rr�f ��Ctrl LIaS �� I% �� c� �� <br />CONTRACTOR q � `- ADDRESS c ' : i ; --. � CI'fYIZIP PHONE _ I <br />1 ��� 1'���il\<. tc'-n�'. ' � � �� I<:�„`�l.0 -.lv.-�:�Cl•"y�, ' � ;�:� � 1 <br />CONTR. LICENSE p <br />U5E OF BUILDING <br />� . � I '� t I '�� •� � <br />I\ .��: L <br />WORK DESCRIPTION <br />NO. <br />TYPE OF FIXI'URE OR ITEM <br />Toilel <br />Balhtub <br />lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/barlmop/etc.) <br />BackAow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />HEAT SOURCE ' <br />Eledric �v,as _ Other <br />�.� : <br />�JC_y�. ��)r�� � ��� <br />CON'i RACT PRICE OF WORK <br />J <br />MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />� Gas piping — � <br />Waler heater <br />Gas hreplace <br />Gas range <br />1 Clothes dryer � <br />Range hood <br />Exhaustfan <br />Heal pump <br />Unit heater <br />� Boiler <br />—I Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />(-ti�jL')'✓ <br />I hereby ceritify that I have read and examined lhis application and know the same to be true and cortect. All provisions of laws and <br />ordnaces goveming this type of work vnll be complied �+nlh whether specified herein or not The granting of a permit does not presume <br />to give authority to violate or cancel the provision o! any other state or tocal law regulating construclion or the pedormance of <br />cn�ction. Tha!� authorized by the owner o�iS property to pertorm the wo�fo � ich�, � tion is made and I compty with the <br />State Contradors Law 18 27 4 nd 296200 AC. <br />� ,�� 9 <br />� <br />