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P���MIT APPLICATIG�J <br />CIl'Y OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERFTi, WR 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />�! , <br />LEGA LOT N0. <br />DESC. <br />Lve�el-� � W <br />eve�l� Lr� <br />f j Gl V IrlOilc� L. <br />TENANT AME <br />Unocc���e� <br />CONTRACTOR <br />CONTR. LICENSE p <br />USE OF BUILDING <br />�en�� I <br />WORK DESCRIP710N <br />G r1CI <br />fen-l-a <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Ctothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />�-T PARCEL TAX I.D. # <br />TRACT <br />MADDRE55 CIT <br />HIZ S� <br />;� �0.�rVi-✓ Lv��r�l� <br />CON'ACTPORPERMIT <br />IZa�r�u�l d L. l,J afrLo.t/ <br />AUDRE55 <br />S+J� ��f25�%�U-� <br />��2� <br />l.�c M-(-'��N�3u - �I :3:� <br />� I-�z�-S�Z�-�-I% <br />CITY2IP PHONE <br />HEAT SOURCE I CONTRACT PRICE OF WORK <br />_ Electric � Gas _ Other <br />N0. I TYPE OF FIXTURE OR ITEM <br />AIC — alr handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas flrepla^.e <br />Gas range <br />Clothes dryer <br />Rangehood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Bc�ler <br />Refrigeration <br />W.odstove <br />Other <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 7105 <br />I hereby ceritify that I have read and examined this applicalio� and know the same to be true and corcect. All pravislons of laws and <br />ordinaces governing this type of work will be complied wilh whether specified herein or not. The grantin{� of a permil does not presume <br />to give authonty to violate or cancel the provision of any olher state or local law regulating constructlor or the perfortnance of <br />construction. That I am aulhorized by the owner of this property to perform the work for which appl(ce�on is made and I ramply with the <br />State Contract aw 18.27 RCV� nd 2.200 WAC. <br />,-;�,,�r���.� �-� � z/73/� <br />