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P�r�MIT APPLICATIG�J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-881 Q- FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM � AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />LEGA LOT N0. � <br />DESC. z � �. ZZ -� <br />/yqiR��.� �� � �� �6�C✓.h <br />TENANTNAME <br />� � IZ P�w �-o <br />�C TRACTOR <br />.. � �v�pV�$0� <br />CONTR. LICENSE X �� L <br />USE OF BUILDING <br />�� P�<<� <br />WORK DESCRIPTION <br />��� <br />PARCEL TAX I.D. # <br />hY`e CX�y3�j/G79o2lou <br />TRAC7 <br />��w�1- e� �i/.�Ye <br />�/ �0'3 /�G� �'I � <br />CONTACT FOR PERMIT <br />►�.-,�� !'✓� oh�czn <br />ADDRESS <br />��s��iU, �Ctic• r3 217f` <br />��n► �/q I Dr' <br />/'CL�o✓t d�c✓,Tipi� <br />A�� l�c�-i-rv�. w a I lC <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />_ Lavatory (wash basin) <br />_ Shower <br />_ Kitchen sink & dfsposal <br />_ Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Greasetrep <br />Roof drains <br />Other <br />PHONE <br />vzs 47b' c3ti d <br />CITY2IP PHONE <br />�l SC ��-� 1 f 1.�.� (%- ��1� Z I <br />HEATSOURCE <br />�ecMc _ Gas _ Other <br />w a �� e lt�u L�H <br />@ IUG �,�. P� <br />yz� 4�Y o3tit <br />CONTRACT PRICE OF WORK <br />� � /Y cU � � w <br />� 1-- <br />Gw�-e F <br />NO. � TYPE OF FOCTURE OR 17EM <br />wc; — air nanmmg urnts <br />Forced afr systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas renge <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OP EVERETT LOCAL SALES 7AX CODE IS 7105 <br />I hereby ceritify that I have read and examined this applicatlon and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construcUon or the perfortnance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State C ors Law 1827 RCW and 296.200 WAC. <br />L� � G--'—' �7� 3`�-0� <br />Sg at e of wner/ ontractor/Authonzed Agent ate � <br />Z <br />