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SITE ADDRESS <br />NO. <br />�� <br />TENA�T DlAME <br />� � :> � <br />/ r�'�,ft:� ; <br />PERMRT �4PPLICATION <br />CITY OF EVERETT �'EFZMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — v✓ww.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PA[2CEL TAX I.D. # <br />; �i Kii�� �ft�� � <br />FOR PERMIT <br />)l�s` N��J�OUSE <br />a -D 7-D 6 <br />PERMIT # <br />� ��C�C���X-�r1� <br />i �i� � (r� �cx k <br />�v_ �!/E', i�'.�'�'�?n <br />PHONE <br />a� 57/ alvl y <br />CONTRACTOR ADDRESS �1 `CIT,YIZIP / PHONE <br />���lC�� ICCS� 1-Y1C . Ct �il ��� 6111C��11� KVii �7}��Li.�i`� 7��0 <br />CONTR. LICENSE �OPiDIS I.l—C-����rl 1� l�7 s���9S �� <br />USE OF BUILDING � HEAT SOURCE I CONTRACT PRICE OF WORK <br />� <br />_ElecUic �as_Other I �,�/£r-j �C��' <br />WORI<DESCRIPTION ��� j��lnt>C-qC {2�:���('S <br />� <br />� <br />TYPE OF FIXTURE OR ITEM <br />Toilet <br />8athtub <br />Lavatory (wash basin) <br />Shcwer <br />Kltchen sink & disposal <br />Dish�yasher <br />Clothes washer <br />Laundry lray <br />Sink (service/badmop/etcJ <br />Backflow preventer <br />�al �'' N� <br />Drinking Fountain <br />Floor drain <br />Greasetrap <br />Roor drains <br />Other <br />� � <br />�' r <br />1)'� <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />� Forced air systems <br />/ Gas piping <br />% Water heater <br />Gas fireplace <br />/� Gasrange <br />'C,bthes dryer <br />/ Ra�ge hood <br />� Exhaustfan <br />_ Heat purli 0. <br />_ Unit heater \� <br />_ Boiler <br />Refrigeration <br />Woodstove <br />Other _ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />I hereby c.ritify lhat I have read and examined this application and know lhe same to be true and correcl NI provisions of laws and <br />ordinaces goveming this type of work will be complied with �vhether specified herein or not. The grenting of a permit does not presume <br />to give autho:ity to violate cr cancel the provision of any other state or local iaw regulating construction or the performance of <br />construcliop That I am authorized by the owner of this property to perform the work for v:hich appiication is made and I comply with the <br />c���o c��rJ���n� aw �A 77�kCW and 7_96200 WAC. . <br />`. f � �l -�. <br />� -�} j� �) (� � <br />�Iz <br />