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PEI�MIT AP'PLfCATION <br />C�TY OF EUERETT PCRMIT 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 Phl <br />SITE ADDRESS <br />�(���i �v�. rcen (-l�a <br />LEGAL LOT NO. BLOCK <br />DESC. <br />%'v ��(�N" <br />TENANT NAMB <br />a��s�� a� zrs�«�.� <br />�(��n ;� I V Co�ST �55� • ��'G <br />t'JC � .• (. <br />CONTR. LICENSE # ��, � FGAQCJ �- �-Z- <br />USE OF BUILDING <br />oF�=�� s���� -G <br />WORK DESCRIPTION <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION # <br />CONTACT FOR PERMIT <br />�Tdd /-�-Ez� r <br />nooHr�� <br />�8�3 Sl�:�lry Rd <br />` . I HEATSOURCE <br />,_ Electric k� Gas _ Other <br />q ���i��J <br /># <br />�,�-3Ss'/�13 <br />PHONE L-�� � a138 - 144� <br />Srolx�m �s h <br />�a�o <br />,�,.�� <br />��asi <br />a3a- t9Qa <br />CONTRACT PRICE OF WORK <br />( c.�pcsJ �= <br />Re�uz-l-;�r� of Ek-�-�: �r-' / S-lo(� t�%, I�;� <br />5-�orc in�.�itt ` <br />RC'(�7v2+�Gl� B� �Y�S�.nG� iC2F" �Ji?liC,25� <br />J <br />ur�.�� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Ba�hlub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (servicelbar/mop/etc.; <br />Backtlow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease irap <br />Roof drains <br />Olher <br />I�� k <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhausl fan <br />I-leat pump <br />Unil healer <br />Boiler <br />Retrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined this applicafion and know the same to be irue and correct. AII provieions of laws and <br />ordinances governing lhis type of �vork will be complied with whelher specified herein or not. The granling of a permii does not presume <br />lo give aulhority to violale or cance� the provision of any other slale or local law regulaling construclion or lhe pedormance of <br />conslruction. That I am aulhorized by the owner of this properly to periorm lhe work for which applicalion is mada and I comply with the <br />Slate Gonhactors Law 18,2�7 RCW and 296.200 WAC. � <br />Q � � d /� <br />Dal <br />