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P��RMIT APPLIGATI(�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETf, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM _ 3 �a 6-o Z <br />SITE ADDRESS <br />t"il�f3elred�rn /-��� <br />LEGA LOTNO. BLOCK <br />DESC. <br />TRACT <br />PARCEL TAX I.D. p <br />(�'-�icl� �-ilr-f' �/Xl(� /3�IJPcicrt /��� �✓tre1� 4LS 4�b'-ySyy <br />TENANT NAME � CONTACT FOR PERMIT PHONE <br />��R <br />6�iA+� SAI�� ( 4'ys) 3tS- 3o i�- <br />CONTRACTOR�I��io D�'Jli�hs�„�C;'nr{�,�ADDR9YJCbc.11T„iI La�GJ, M�Kj�hr��WAPHO��s-3/S',�o/�. <br />CONTR. LICENSE N 5 <br />USE OF BUILDING <br />�� <br />WORK DESCRIPTION <br />HEAT SOURCE � � I CONTRACT PRICE OF WORK <br />L/ 4' 10 JUD. � <br />Elactric _ Gas _ Othor <br />�ihish;nf �v� Un-�iniS�Y.+� <br />PLUMBING <br />Np, I TYPE OF FI%TURE OR ITEM <br />1 Toilel <br />Ba�htub <br />� Lavatory (wash basin) <br />Show�r <br />1 Kilchan sink 8 disposal <br />Dishwash�r <br />Clo�hes washcr <br />W ater hoaler <br />� Sink (servicelbarlmoplelc.) <br />_� BackOow preventor <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Greaselrap <br />Roof drains <br />Olher <br />d ak,�.�.� I- <br />�ZsO <br />NO. I TYPE OF FU(TURE OR ITEM <br />�_ <br />A/C - air handlinp units <br />forced air syslems <br />Gas piping <br />Water hoater <br />Gas firaplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit healer <br />Boiler <br />Refrigoration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7705 <br />I hereby cerility that I have read and examined this applicalion and know the same to be lrue and correcl. All provlsions o( laws and <br />ordinacos goveminc� lhis type of work will be complied wilh whether specified herein or not. The granling of o permit does not presume <br />to give authority to violatct or cancel tho pmvision of any other state or local law rr.gulating construction or Ihe pedormance o( <br />construclion. That I am aWhorized by the oHner of lhis property to peAorm the work tor which apalicalion Is made and I comply wilh lhe <br />Stale Conlraclors Law 182] RCW and 296200 WAC. <br />3/L(o /o <br />Sign— afu�of OwnedConlractorlAuthorized A�7ent --�Date // <br />`, � . Y <br />