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PtRMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVEREl�f, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />SITE ADDRESS <br />��'v �i �y'� Y� �2e Ev <br />GAL LOT NO. � <br />DESC. <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />� <br />i�j ,4� �y�� <br />BLOCK <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION # <br />� RM�j# � <br />> <� � � `OO.i� <br />�'��Z�t=�c�f c�-�,�;��, /(,��-iiyM ���'�' sr�� ���-zrr�v�,���,r s�'� ys-�. y7�'r <br />TENANT NAME CONTACT FOR PERIdIT PHONE /,1 � j%.� ��F �� <br />I� f� <br />,,r.:��C/�"�I1G�I �tYv 1 %.���� E-MAIL <br />CONTRACTOF AODRESS CITVIZIP P ONE <br />i�.�r�l 5�6�� SL:���IC�J" /(r2/� ��"ITf�LC cv�i,c7�7" ,. ya1,.;�.�/G< <br />coHrR. uceHse tt Fl� ,� �, ,� /�l//cC. i,� rt7C <br />5'/',T'7S""`7�c�PQ �'Z���� � rL�/ C�//j p,�-0/2 <br />USE OF BUILDING � HEAT SOURCE I CONTRACT PRICE OF WORK <br />l � <br />; r7t,�v'„ 1; "(e <br />WORK DESCRIPTION <br />Electric _ Gas _ Other I � � � v <br />/- G o'— <br />/✓Jt7i9L� �n/�-' CHnn�� Lt:772� �DISi°�,�i�! <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Balhlub <br />Lavatory (�vash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Waler heater <br />Sink (servicelbar/mop/elc.) <br />Back(Iow preventer <br />'rinal <br />�nking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />FVC — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhausl fan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Vvoodstove <br />Other <br />CITY OF EVERE I'T IOCAL SALES TAX CODE IS 3705 <br />I hereby cerilify thal I have read and examined lhis application and �cnow the same lo he true and correcl. All provisions of laws and <br />ordinaces governing lhis lype of work will be complied wilh whether specified herein or not. The granting of a pe niit dees not presume <br />to give aulhority b viola;e or cancel lhP provision of any olher stale or local law renulaling construction or lhe performance of <br />construction. That I am aulhorized by lhe oe+ner ot Ihis property lo perform the a:ork. for which application is made and I comply with the <br />State Conlractors Lav+ 1827 RCW and 296.200 WAC. <br />�� S�Z �/ °� <br />SignaWre of nedConlreclodAi thorized Agent Da,e �IL <br />