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P�r�MIT APPLICATIGnI <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 � <br />425-257-8810 — FAX 425-257-8857 — wvnv everettwa org <br />. . P c/r� —0�3 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREGIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # PEg� �T # <br />� C J Pi"v� c:a' �t -cn3-orl -oi C.- t/l�-'d/3 <br />LEGA LOTNO. BLOCK TRAC7 <br />DESC. I s`�%' � L.-+ -OI�I <br />����e� J-�.b��� 18zt ��1�� OS� M��.Y�;\7e�, ri-SA,A�a�is yzs�.�l�•-14sb <br />TENANTNAME CONTACTFORPERMIT PHONE <br />'— �� .T�b�.e cell �)zS ^� �3�i-�loz".� <br />CO��RAPTrO�� �,N�� �� ADDRESS ;q� \ qTY21P PHONE <br />18a\ 1D� mu.)�c;11eo, �zs-,�9a�1'-IS(o <br />CONTR. ICENSE # <br />/����.GT�.ToSSY�hi- l,a -I �( - n(o <br />USE OF BUILDING <br />� �=.�'�, <br />WORKDESCRIPTION i^` �� C �n \ <br />� U > !— <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet � , <br />BathWb `J/5��;c.u��� <br />Lavalory (wash basin) � / j <br />Shawer <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (servicefbar/mop/etc.) <br />BackFlow preventer <br />Urinal <br />Drinking Fountain <br />Floor drein <br />Grease trap <br />Roof drains <br />Other_ __ <br />� <br />URCE CONTRACT PRICE OF WORK <br />as�Other /l�S 3�� <br />/iG'D(c C(Og SC� <br />MECHANICAL <br />N0. I TYPE qF FIXTURE OR ITEM <br />A/C - air handling units <br />= Forced air systems <br />Gas piping <br />14'ater heater <br />Gas fireplace <br />Gas range <br />� Clothes dryer <br />Rangehood <br />�_ Exhaustfan /%� <br />Heat pump <br />Unit heater <br />Boiler <br />Re(ngeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br />I hereby ceriti(y that I have read and examined this application and know the same to be true and wrrect. All provisions of laws and <br />ortlinaces governing this type of work will be complied wilh whether specified herein or not. The granting of a permit does not presume <br />to give authority ro violate or cancel the provision of any other state or local law regulating construciion or the performance of <br />construction. That I am authorized by the owner of lhis property to perform the work for which apptication is made and I wmply with the <br />State Cont ctors Law 18.27 RCW and 296.200 WAC. <br />i <br />�,,�� % I r�' aq- 04 �/1 t,c� 5�s <br />Signature of Owner ntrac;or/Authonzed Agent Date i/� <br />