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P�RMIT APP'LICATI(,�� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — wwrw.rverettwa.org <br />�.-i7`DJ' <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NCT ACCePTED <br />SITE ADDRESS <br />�OS QVtX <br />LEGAL LOT NO. ' <br />DESC. ��- b0 <br />Q <br />TRACT <br />f� <br />PARCEL TAX I.D. # <br />� io�l- %$�3 <br />TENANTNAME / � I CONTACT FOR PERMIT PHONE <br />�{ ��° 61o�k �f��� t��o�.,�, �{rs ��6-k`"s3.s- <br />CONTRACTOR �f! N[c..V Cd AD6RESS CITY2IP PHONE <br />� 7400 //4r��suv �ru �t.� 77� ��3•S— <br />CONTR.LICENSE# ��r�yNGo]]cM �,ycr�.�� l.�i 5�zo3 <br />USE OF BUILDING <br />J-NSUf�lut� <br />HEATSUURCE <br />_ Electric _ Gas _ Olher <br />WORK DESCRIPTION <br />ftiS��fCC �!i $c{- oF Pfu G�'�NNcL Lsf�crS <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />6athtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Back(low preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />� <br />CONTRACT PRICE OF WORK <br />.�''3� 99Y .-� <br />TYPE OP FIXTURE OR ITEM <br />A/G—zirhandling units <br />Fc--ed air systems <br />Gas piping <br />Water heater <br />Gas fireplaco <br />Gas range <br />Clolhes dryer <br />Range heod <br />Exhaust fan <br />Fleat pur,ip <br />Unit healei <br />Boiier <br />Refrigeration <br />4Voadstove <br />Other <br />CITY OF FVERETT LOCAL SALES SAX COOE IS 3105 <br />I hereby ceri6fy lhat I have read and examined this applicalion and know the same lo he lrue and correct. All provisions of laws and <br />ordinaces governing this lype of work will be complied wilh whelher specified herein or not. The granting of a permit does nol presume <br />to give aulhorily lo violate or cancel the provision of any olher state or local law regulating constructlon or lhe per(ormance of <br />construclion. That I am authorized he own f lhis property to perform the work for which application is made and I comply witn the <br />Slate Contractors L,,�i 18.2� o.?� AC. <br />��L <br />