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f <br />P�RMIT APPLICAT�GN <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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />LZC�I <br />LEGAI LOT NO. <br />DESC <br />BLOCK <br />tG�G 5iR N/ �RlSTo <br />PARCBL TAX I.D. # <br />���a��.� vo�oe <br />TRACT <br />�iro r�o�6y ��.�c , �v�RcrT �saa3 <br />PEF`nIT ,: <br />Co41 i - <br />TENANTNAME CONTACTFOR PERMIT PHONE <br />�P�i1' F1 F�/�NL'O ,�5.3 333-/� /3 <br />CONTRACTOR AODRE55 CIIYGIP PHONE <br />CONTR. LICENSE � I � �� <br />USE OF BUILDING <br />5�,��-�� FAM,�y <br />HEATSOURCE <br />�Electric Gas Other <br />CONTRACT PRIC'e OF WORK <br />�,Z <br />WORK DESCRIPTION <br />DC/�1CL�/s/� CX/STiNG /'f/l�N F�OoR� /NCG�.cDiNc P/lF�T/T/C/✓ �n� <br />,��5�f�;vi Coti•�i,�ucT Bui� �i�vc PC� �r�N. <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchcn sink 8 disposal <br />Dishwasher <br />C�othes washer <br />Laundry tray <br />Sink (service/badmop/etc.) <br />Backflow preventer <br />Unnal <br />Dnn�;ing Fountain <br />Floor drain <br />Grease trap <br />Roo( drains <br />Cther <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />/ r Forced air systems <br />� Gas piping <br />� Water heater <br />� Gas fireplaca <br />� Gasrange <br />�Clothes dryer <br />Range hood <br />Exhaust fan <br />Hoat pump <br />Unil heater <br />Boiler <br />� Refrigeretion <br />Woodstove <br />C�TY OF EVERE7T LOCAL SALES TAX COOE IS 3105 <br />', I hereby ceritify that I hava read and examined th!s application and know ihe same to be !rue and correct. All provisions of laws and <br />� ordinaces goveming this type of work will be complietl with whether specified herein or not. The granting of a pertnit does not presume <br />to give authonty to violate or cancel the provision of any other siate or local taw regulating construction or the performance of <br />construction. That I am authonzed 5y the owner of this property to perform the work `or which application is made and I �amply with the <br />State-C-on[raCors.�ev+ �B.ZTk'CV�Cand 296200 WAC. <br />4%- <br />