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PEr2MIT APPLICATIG,J <br />CITY OF EVER�TT PERMIT SERVICES <br />3200 CEDAR S i REET, EVERETT,'NA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org �` a� �� <br />ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITEQDDRESS �Ve��i '�/F�a�' <br />G o f�%''3 /�.�'e /ec,G c.✓e �e cwe <br />LEGAL LOT N0. BLOCK <br />DES0. ,3 <br />PARCEL TAX I.D. # <br />0o y /7/ -ooa - UZ <br />TRAC7 <br />�No�ey G.�.sw yaoq _._a�s�2 s'w ��;�4���0 �yzs �.so-sa�c <br />/2��vA Gvs<_v.d- _- <br />TENANT NAME i CONTACT FOR PERMIT PHONE <br />CONTRACTOR <br />CONTR. LICENSE p <br />USE OF 6UILDING <br />� <br />C�- <br />\.J <br />� � �C c��c� <br />WORK DESCRIPTION <br />(,i.�ti �%°/L-.S �(. �'i �Cc�ll- <br />NO. I TYPE OF FIXTURE OR ITEM <br />rl <br />�/ <br />Toilot '. <br />6alhtub : ' <br />L�valory (wash basin) / ��/ <br />Shower ;i <br />Kitchen sinl: & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (servico/bar,'mop.�etc.) <br />Backllow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Greaso trap <br />Roof drains <br />Other _ <br />ADDRESS <br />HEATSOURCE <br />_, Electric F Gas _ Olher <br />�� .{ <br />��! .ti C" < C' <br />CITY2IP PHONE <br />CONTRACT PRICE OF WORK <br />� 333,9?7 -: <br />,c� �_ a" � i� ��v eC <br />N0. I 1YPE OF FI%TURE OR ITEM <br />A/C — air handling units <br />% Forced eir systoms <br />� Gas piping <br />i W�ter heater <br />� Gas fireplace <br />/ Gas range <br />% Clothes dryer <br />i Range hood <br />� + Exhaust fan /%��. <br />Heat purnp <br />Unit heater <br />Boiler <br />� Reirigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 7105 <br />I hereby ceritify tnal I have raad and oxamined this appiication and know the same to be trua and correcl. All provisions of laws rind <br />r,rdinaces goveming Ihis lype of work will be complied with whelher specified herein or not. The granting of a permit does not presume <br />to give authority to violate or canc2l the provision of any olher state or Iecal law regulating conslruction or the performance of <br />wnslruction. That I am aulhorized by �he owner ol lhis ,:mperty to peAurm the work for which application is made and I comply with lhe <br />Stale Contractors Law 1�2� RCW and 296200 WAC. <br />. <br />���/ �l r/i�fi <br />'/z <br />