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PE'��MIT APPLICATI��� <br />CITY OF EVER�TT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98'L01 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />� ��! �Y�I Y N� �. �'.' y .�-�-�--- <br />LOT NO. BLOCK TRACT <br />-riEn�n �- � rt���4 c.��- <br />TENANTNAME <br />�1G2q r�� <br />CONTRACTOR <br />o�1r�c,�t F� �« Py��`���� �u� <br />CONTR, LICENSE # n�T � C� FI � <br />— � � <br />USE OF BUIL�ING <br />WOP.K DESCRIPTION <br />PARCEL TAX I.O. �f <br />rr� C✓� �o.. <br />�OR PERMIT <br />ADDRESS <br />Si3Y s_ ��t r ��� s r <br />7PS <br />HEATSOURCE <br />Electric Gas Other <br />2G <br />CITY2IP <br />sr�.�f-+c <br />W�l <br />PERPAIT # <br />L:[�L`L� <br />PHONE <br />�//B <br />2e� 7z3 j�lz <br />CON7RACT PRICE OF WORK <br />�jYT S�.�JYYSSiOv� Sy5'��i..� (`^Sr�\IL'�10�.. (k 1'GHIp�%oVc! <br />ri <br />(�Ct -i c Ct t' �n c� N� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/har/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />Y.O- � TYPE OF FIXTURE OR ITF.M <br />A/C — air handling units <br />_ Forned air syslems <br />Gas p�ping <br />Water heater <br />Gas fireplace <br />Gas range <br />Cbthes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Re(rigeration <br />Woodstove <br />� Other�T S�,�YrSSio� <br />_ �y S; _ _i— <br />CITY CF EVERETT LOCAL SALES SAX CODE �S 3105 <br />I hereby ceritify that I have read an� examined this application and know the same to be true and correct. All pruvisions of laws and <br />ordinaces goveming this type of wcrk will he complied with whether specified herein or not. The granting of a permit does not presume <br />to �ive authonty to violate or cancel the provision of any other state or local law regulating consWction or the performance of <br />construction. That I am auihorized by the owner of this property to pertorn Ihe work icr which applicaticn is made and I compty with the <br />State Contractors Law 1827 RC'N ard 286.200 WAC. <br />.l'�%,i ,(� �i'�t, n'So C� 9/ C� I/C� 1" <br />