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P�RMIT A�PLlCATI(,.N <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 <br />SITE ADDRESS 7i ��u eQ/c �„�a 10.� ,�j�j <br />r� yb XK � <br />PARCEL TAX I.D. il <br />�or N�. ,3 3 BLOCK iftACi � <br />�•• ! -- / <br />.J„ `�Li <br />.,..,.", y� ✓ � E,v� � <br />��rpE�,rLo <br />TENANTNAME <br />1 ' ' i <br />CONT ACTOR �,�r <br />C a,ea3g 6Lc � <br />CONTR. LICEN5fi7�. �l .'��'����� � <br />USE OF BUILDING • <br />WORK DESCRIPTION <br />���� ,� <br />/6-9d0 33�DAoESE <br />... ���� ���- or�� <br />,� P MITp � <br />r �/� �'��.� <br />_ � <br />�l,� i ,� r _ <br />LIP PHONE <br />i// qeo�i S'.� S 3 �6 3 e 4� <br />�e., ..�. <br />ICONTACT FOR PERMIT / PHONE <br />�_f/C_./� %;%t �C'C'�' . r�� �i p�'�'�/�. �'.iSOl7 <br />ADDRESS CITYIZIP PHONE <br />i.� �a B, . ,, , d. ��c.d,�3 6.�� <br />:.nj,q��...e.�J��� ��+!�k� . <br />�,�T_� c✓If ��IG�IL� <br />, �;� ,. t•.,ya �' HEA7 SOURCE I CONTRACT PRICE OF WORK <br />_ Elec�ric g_ Gas _ Other <br />S�iIJ(� �/7/�/��� /` <br />� c S � a�E /� Ge' <br />N0. I TYPE OF FI%TURE OR ITEM <br />I v <br />Toilet <br />Balhtub � �� <br />Lavalory (wash basin) � <br />Sh�wer <br />Kitchen sink 8 disposal <br />Dishwashor <br />Clolhes washar <br />Laundry Iray <br />Sink (scrvice/badmop�etc.) <br />Back(low prevenler <br />Urinal <br />Drinkin� Fo�mlain <br />Floor drain <br />Greas� trap <br />�oo( drains <br />Other <br />i --- -- <br />, I hereby carilify �hat I have read and exar <br />'� ordinaces 9oveming th's type of work will <br />�I to yivr, authorily lo viol fg o r.ancel �ho p <br />� consiruclion. Thal I am �u1h i�ed b lhe <br />� Statr. CoNractors Law 1.2 �W a�d 2 <br />ISiqnature o( OwnedCoNracbdAuthonze <br />l-- ------... .__..__ ____ _.. .._ <br />NO. I TYPE OF FIXTURE OR ITEM <br />— A/C - air handling units <br />t Forced air syslems <br />To Gas piping !� f <br />� Watenc�atcr <br />� Gasfiroptaca /-/I <br />Gas ran�e <br />I Clolhes dryor <br />1 kan�ohood <br />� Exhaust tan �I �) <br />/ Heat pump <br />T Unit h�ater <br />1 BUII@f <br />� Refngeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />Ihis <br />�iication anA know tho samo to be vue and correcL All provisions of laws and <br />v�ilh whether speciliod herein or not. The �ranling o( a permil does not presume <br />y other ,late or local law regulaling conslruclion or lhe pedormance ol <br />property lo per(orm Ihe work for which ap�licalion is mado and I comply with fhe <br />/L <br />