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SITE ADURESS <br />LOT NO. <br />OESC. <br />^EF:MIT APPLIC�►T''1N <br />CITY OF EVERETT PERMIT' SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.evereriwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 �M <br />m� �- <br />I BLOCK I TFtACT <br />PARCEL TAX I.D. M <br />� � ,��_ ,� � <br />�1�,/'�-, .: �- <br />N <br />....��.. �{///y //!�"--..--- -�---.. ._---rL.7-�oa.r� <br />.. �n R�'i �.t/E 1io�. (Q;FaSr�itr 9��" <br />TENANT NAME CONTACT FOR PER�AIT PFiONE <br />�l�-�2�Ca(/Q/�heJ �15-75�1-/s�'P` <br />CONTAACTOR L, nm�� � DDRE85 " CITY2IP ��N�� <br />,l1Q (' <br />CONTR.L�CE��JnDNL��-O �I�� �i��/�IDZ� �2��o�L/ZJ' <br />USE OF BUILDING <br />WORK U SCRIPTION <br />��'� 2b3 <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toilot <br />Be�hWb <br />Levetory (wash basin) <br />Shawer <br />Kitchen sink 8 disposel <br />Dlshwasher <br />Clothes wasfier <br />Laundrytray <br />Sink (servicelbadmopletc.) <br />Backflow preventer <br />Urinal <br />Urinking Fountain <br />Floor drain <br />Grease trep <br />Roof drains <br />Other <br />HEATSOURCE <br />_ Electric ✓ Gas _ Other <br />�l/A- <br />CONTRACT PRICE OF WORI< <br />N0. I TVPE OF FIXTURE OR ITEM <br />AIC — eir handling units <br />Forced eir systems <br />Ges piping <br />Waler heater <br />1 Ges fireplece <br />L Ges renge <br />1_ Clathes dryer <br />_.[- Renge hood <br />Exheust fan <br />_ Neal pump <br />Unit healer <br />'� Boiler <br />Refigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL 8ALE9 TAX CODE 19 7106 <br />1 herehy ceritity thet I have read and exemined this applicetion end know the same to be true and correcl. All provlsiona ot lews and <br />ordinaces goveming this type ol work will be complied with whether apeGfied hereln or not. The grenting uf e pertnll does not ptesume <br />to give euthority to violate ar cencal Ihe provislon ol eny other stete or local law regulating constructian or the pertormence ol <br />construction That I em euthonzed by lhe owner o1 this property to pedorm the work tor whfch epplication is mede end I comply with the <br />State Contrectors Law 18.27 RCW end 298.200 WAC. <br />Signatura o wnerl ontraclorlAut orize gsnt ete <br />`�z <br />