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i <br />P��RMIT APPLICATI(�N <br />CITY OF EVERETT PERMIT �ERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ��� a/�S <br />SITE ADDRESS �� PARCEL TAX I.D. # /PE�RMITiI <br />�2�1 �Na�l.�� � ��r��}, qosl-roo2�3�oe�_ ( _`i�9' �3 <br />�'i.�1 o S � � cmzi zc�n; � <br />LEGAL LOT N0. � BLOCK <br />DESC. � ' <br />I � � '`�TfZ •�L�. ' PP2:TT1� .5 �--LG� <br />TENANTNAME <br />TRACT <br />ADDR!:SS <br />121q`j \/I�LA��L <br />c_ �—�.,rt� P�-. � <br />CONTACT FOR PERMIT <br />MV�LI �iLO �. � • ' <br />c�..,._!- S4$•�7 <br />PHONE <br />I �.j�„�. ���� ��ZCJ�3�a'��-, . <br />CONTRACTOR � ADDRESS CITY2IP PMONE <br />CONTR. UCENSE # " <br />USE OF BUILDING <br />12��..\Ot-�..��"IA.I.. `o.F <br />WORK DESCRIPTION <br />��r.,r��; �ic9r—� <br />�f �1 �• (z-�. C�-�• � . <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathlub <br />_ Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Laundry lray <br />Sink (service/bar/mop/elc.) <br />Backilow preventer <br />Urinal <br />Drinking Fountain <br />_ Floor drain <br />Grease trap <br />Roo( drains <br />Olhc.r <br />h •' <br />HEATSOURCE <br />[leclric _ Gas _ Olhcr <br />CONTRACT PRICE OF N'ORK <br />2 _-� e�cx`� <br />NO. I TYPE OF FIY.TURE OR ITEM <br />A�C — air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Cblhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woadslove <br />CITY OF EVERETT LOCAL SALES TNf CO[�E IS 3105 <br />I hereby ceritify lhat I have read and examined this applicalion and kno�v lhe same lo be irue and correcl. All provisions of laws and <br />ordinaces governin� this type of work �eill be complied with whether speci(ied herein or not. The granling of a permil does not presume <br />to give aulhonty to viQlale or cancel the provision of any other state or local law regulaling conslruclion or the performance of <br />construction.-Fhdt l a�eWhorized �y the owner of this property lo peAorm the work for which application is made and I comply with the <br />State Contraptors L ia {� 1g.27 RCW nd 296.200 WAC. � <br />' �z <br />