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SiTE ADDRt�3 <br />t'/S'oo <br />LEGAL LOT NO. <br />DESC. <br />S//e�-rJ <br />TENANT NAME <br />PERMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-&810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �, � g�D <br />PARCEL TAX I.D. # <br />TRP^.T OR SUBDIVISION ri <br />ADDRESS CITYIZIP <br />n� 7��/ L GJUr� 1�9�o db7+z�y, T <br />0 <br />CONTACT FOR PERMIT <br />�%c / 4��crr�cr <br />/� <br />CONTR. UCENSE ii �/ C(',UVCi�J <br />USE OF BUILDING <br />Gh�rc <br />HEATSOURCE <br />_ Electric � Gas _ Olher <br />WORKDESCRIPTION�J�aUG ,�'i�;� �� � (,Jci(� q)j� <br />� � ��,,... <br />tti��t �v �,,.� �i� �''v��-, j�.��r, <br />�1�'c c <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />�athWb <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow prevenler <br />Urinal <br />Urinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />PERMIT 1f <br />90/ �2 <br />PHONE GIaS �6��' /��,� <br />CONTRACT PRICE OF WORK <br />� Z oc� <br />-e-�."(,'-ry �'/yG'7v�Y <br />MECHANICAL <br />TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas pipinc� <br />Water heater <br />Gas fireplace <br />Gas rango <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heal pump <br />Unil healer <br />Boiler <br />Retrigeralion <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />I hereby cerili(y that I have read and examined lhis applicalion and know the same to be true and correcl. All provisions of Iaws and <br />ordinaces governing this type of work will be complied with whelher specified herein or not The granting of a permit does nol presume <br />lo c�ive aulhority to violale or cancel the provision o( any other slate or local law regulating construclion or the pedormance of <br />construction. That � am authorized by lhe owner o( lhis property lo peAorm the work for which applicalion is made and I comply with the <br />Slale Conlrac rs Law 18.27 RCW and 296.200 WAC. <br />l: - ����. L ���.�i�� <br />Signalure of Ow edConlraclor/Authorized Agenl Date �/ <br />i <br />