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PtRMIT APPLICATIGN <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 />c.� �'w;'�� ���`I <br />� ��'�;GC� <br />d <br />6 .a6-o� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />LEGALI LOT NO. <br />DESC.r y <br />PARCEL TAl( I.D. # <br />s�r>� �s93`!-c��F <br />TRACT <br />PERMIT # <br />o�� Co�o� '60G, <br />��ua,r �.'.,e,� ( `��s;- �.�c. � /�o acr ;3v"� /JuvA« %�U/9 1.oC, �/`•''- �y/3 <br />TENANTNAME I CONTACTFORPERMIT PHONE <br />/��%/,�� �-�/.L' �TiF �.oE. G/% - �-yi3 <br />CONTRACTOR �- ADDRESS CITY2IP PHONE <br />-T���.� �Z,�j6F ( o'.cis; /,vc. -7�, •c�3<<z :x�L. �c ._.v.4z.c.. :'b�3�`% <br />� .: <br />CONTR. LICENSE k <br />`3�.<.� m�.z9�'�= T� <br />USE OF BUILDING <br />� 1=i2 <br />WORK OESCRIPTION <br />H_ATSOURCE <br />_ [leciric Y Gas _ Othar <br />NC.'�/-.� �(�f�'�J � .7li'.t.t%.� L�%�c� <br />NO. I TfPE OF FIXTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Laundry tray <br />Sink (service/barlmop/elc.) <br />Backflow preven�er <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Rool drains <br />Olher <br />zA� G/�-�y'i3 <br />CONTRACT PRICE OF WORK <br />% z S�, C�CYl7 - <br />/�.4.; /C �// 9-!� <br />NO. I NPE OF FIXTURE OR ITEM <br />A/C - air handling unils <br />/ Forced air syslems <br />� Gas piping <br />/ Water heater <br />/ Gas fireplace <br />% Gas range <br />� Clolhes dryer <br />Ran�ehood <br />- G Ezhaustfan <br />Heatpwnp <br />Unit healer <br />Boiler <br />Refrigeretion <br />Woodstovc <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereLy cerilify th2c I have read and ezamined lhis application and know the same to 6e true and correct. All provisions of laws and <br />ordinaces �oveminy this type o( work will be complied wilh whether specifed herein or noL The granting of a permit does not prosumo <br />to give aulhority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />construclion. That I am authorized by lhe owner o( this property to pedorm the work (or which application is made and I comp�y wilh lhe <br />Slale CoNrac% ��aw 18.27 RCW and 296.200 WAC. <br />(r... /.0 `�/'� ��-/2-aG� <br />Siynature ol OwnadContraclor/Authorized Ac�ent Date �/Z <br />