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c <br />P�MIT APPLICATIO <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 - DEBIT 8� CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />%` � �/� c������,�-� <br />LEGAL ��LOT NO. BLOCK <br />DESC. /7'��, f�'' d � <br />.� ;� �.�� �yU l- <br />.. � ". ; 1 <br />�i..� r�' /'J :_� �.�� I�-�.�/t�.��/�: <br />TENANT NAME r <br />/� \1 I <br />f 1 � ,�,x�ti' � ` _�c i �c��'���'��i <br />, <br />CONTRACTOR <br />CONTR. LICENSE # <br />USE OF BUILDING �" <br />( "0 I�%�r�� �(_.- �� <br />� � � �, <br />�'�'�� �,�i�'� �—ka)?? <br />PARCEL TAX I.D. # <br />� `�7`����i'G% <br />�r�' <br />,���- <br />7i? �✓ L' �' <br />CITY/ZIP � <br />/'i r/�I <br />�LG��� � <br />CONTACT FOR PERQAIT <br />,C � �?, � ; ; : �'_c�rl �s�/ti <br />ADDRESS CITY/ZIP <br />HEAT SOURCE <br />Electric �Gas _ Other <br />WORK DESCRIPTION <br />� �r I <br />l� � � � ? =� C` �'T, ` � 1'�i i��1%=_ % �', %` �/�' �'�,�." �f =�% �� L_. <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <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 />Grease trap <br />Roof drains <br />Other <br />PERMIT # <br />'L`fCL`_'%� <br />_PHONE � <br />;= �- �z� <br />,� � 5,=� � y� > <br />L <br />PHONE <br />�. <br />/i S"- � � ;' - �> �% �_ � <br />PHONE <br />CONTRACT PRICE OF WORK <br />— C>e`-� � <br />7 F <br />G � _ <br />MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />' Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I hav� read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governi g this, ype of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority t violate or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. 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 Co � � Law� 8.27 RCW and 296.200 WAC. <br />i \ � J ' -7 � <br />j� � / � �. " `_ �-'�__"'-_ L� / L��� <br />re <br />nt <br />