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SITE <br />PERMII' APPLICATION <br />CITY OF EVE�ETT PERMIT SERVICES <br />3200 CEDAR STR�ET, EVERETi, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www•everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �—� ��� � <br />2ESS PARCEL TAX I.D. # PERMiT # <br />OD �v�la R-f,�n1 W A-�? '� o I- f' <br />LOTNO. BLOCK TRACT <br />`I OOoD- C.o +'f�v�rz��Z th��s 'p.visw�l 3 <br />TENANTNAME <br />����� <br />CONTRACTOR <br />17-a�-�N �� <br />CONTR.UCENSE# <br />USE OF BUILDING <br />� <br />(u`l0 0 �cle�tEta �PV <br />CONTACT FOR PERMIT <br />`��L �h4i'(LQh� ��'R' <br />3$3 <br />PHONE <br />3�0) qi� -�a3a <br />ADORESS CITYIZIP PHONE <br />�������. „�< <Z,., b� ,�� �,�,,� J,����l�a �60� �rs= <br />�,,� , �¢ <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />_ Electric /` Gas _ Other �'3 53� �� �` <br />WORK DESCi21PTION <br />/NST-NZ.L n�� �G�Tf�Dn PsY�NT S�/t!3'/ �3od7,� . �i✓5'T11CL /N��YKG <br />fi�(f � �?'UiT �(/GT �I"S /GY�✓V !/1 FiD �'UIL �Fl-�r✓�— 7SOOTf/ . �—y��}in. L o u T <br />`�vcT Pf./U1iT7Ll{-'(�oi�� '�l.YL- �Y�-I'cT—'FiG'�� fu4NS � C�AS (�I F°IA�C7 � tiR4 �f <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kiichen sink & dispesal <br />Dishwasher <br />Clothes washer <br />Laundry lray <br />Sink (servicelbar/mop/etc.) <br />BackFlow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />N0. I NPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unii heater <br />Boiler <br />Refrigeration <br />Woodstove <br />� Other t�A��liY �ii(�1�( . p,� o�i-{� W� <br />_ iu-j�,d,__�� M'f,CNfH�[��L. N <br />CI7Y OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to viotate or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. That i am authorized by the owner nf this property to perform the work for which application is made and I comply with the <br />State Coptractors Law 18 RC and 296,209 WAC. � � <br />A--�e �^- <br />